High flow or low flow? An unusual case of ischemic priapism following gunshot wound to the cervical spinal cord

Ischemic priapism has rarely been reported in the setting of acute spinal cord injury. Herein, we present a 25 year-old male with cavernous blood gas evidence of ischemic priapism following a traumatic gunshot wound with a retained bullet fragment in the third cervical vertebra. The patient received definitive treatment with corporal aspiration and irrigation, with no evidence of priapism recurrence. This unusual case emphasizes the critical importance of obtaining a cavernous blood gas, even when a common cause of non-ischemic priapism is apparent. Suspicion for ischemic priapism must be maintained, especially in the setting of multiple known risk factors.

Management of genitourinary foreign bodies in a predominantly incarcerated population

INTRODUCTION Genitourinary foreign body (FB) insertion is a rare occurrence. Commonly reported reasons for insertion include autoeroticism and intoxication, however psychiatric illness is thought to contribute in most cases. In the incarcerated population, malingering plays a prominent role. We examined clinical patient characteristics and management patterns for cases of genitourinary FB insertion and sought to identify risk factors for recidivism.

MATERIALS AND METHODS

A retrospective review was performed of all patients presenting to a tertiary trauma center with a genitourinary FB between January 2001-June 2019. Patient demographics, presentation, work up, and management were reviewed. Bivariate and multivariate statistical analyses were performed.

RESULTS

Patients were primarily young (33 yo, range: 21-93), male (92%), incarcerated (67%), and had at least one psychiatric diagnosis (71%). Concomitant FB ingestion was present in 56 (41.5) encounters. Risk factors for repeat FB insertion included incarceration (100.0% versus 51.5%, p = < 0.01), psychiatric comorbidity (100.0% versus 51.5%, p = < 0.01), and other concomitant FB insertion/ingestion (68.7% versus 18.2%, p = < 0.01). Common methods of FB extraction included flexible cystoscopy (33.8%), extrinsic pressure (21.0%), rigid cystoscopy (12.8%), and open surgery (8.1%). Fifty-three (39.2%) encounters required anesthesia and 64 (47.4%) encounters required admission.

CONCLUSIONS

Genitourinary FBs are usually removed via endoscopic or minimally invasive extraction techniques and the majority are located within the anterior urethra. Special consideration should be given to patients with psychiatric comorbidity, concomitant FB insertion/ingestion, or those presenting from a correctional facility as these characteristics are associated with repeat insertion attempts.

Hand-assisted laparoscopic radical nephrectomy for renal cell carcinoma in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare condition with left-right mirror imaging of both abdominal and thoracic organs. While this configuration is rarely of medical importance, an understanding of this unique anatomy is essential in the setting of surgical intervention. Here we review a case of renal cell carcinoma (RCC) in the setting of SIT. The patient underwent a hand-assisted laparoscopic radical nephrectomy. Pathology revealed pT3aNxMx Fuhrman Grade 2 clear cell RCC.