A 10-year Audit of Penile Prosthesis Insertion

Introduction Penile prosthesis (PP) insertion is the gold standard surgical treatment option for men with refractory Erectile Dysfunction (ED). PP insertion is considered effective but has a well-documented array of complications. Our aim was to assess outcomes following single-surgeon insertion of PP for ED within an Irish cohort. Methods Following review of the Hospital In-Patient Enquiry (HIPE) system, a retrospective chart review of all patients who underwent PP insertion over a 10-year period from 2008-2017 inclusive was performed, and an electronic database was analysed for results. Results One-hundred-and-eleven PPs were inserted in 96 patients. The most common aetiology for ED in our cohort was post-prostatectomy, affecting 25 (26%) patients. The most frequently implanted device was a 3-piece inflatable PP (3p-IPP) (AMS 700TM; American Medical Systems Inc., Minnesota, USA) and the peno-scrotal approach was utilised in the majority of patients (86, 77.5%). No intraoperative complications were recorded. Twelve (12.5%) patients developed peri-operative complications. Thirteen (13.5%) patients required device revision, the majority for device failure. Of the 71 patient satisfaction responses, 61 (85.9%) patients were satisfied with their PP. Conclusions This single-surgeon retrospective audit of PP surgery demonstrates complication rates in-line with internationally published data. Patients should be adequately counselled regarding possible complications, including device failure and erosion. PP insertion should be considered for suitable patients with refractory ED.

Two hit hypothesis: an unusual complication following supra-pubic catheter insertion

Osteomyelitis is an inflammation of the bone caused by an infection. Though bone is normally resistant to bacterial infection, events including trauma, presence of foreign bodies including prosthesis can act as a nidus for infection. Osteomyelitis is a rare but recognised complication of radiotherapy. Osteomyelitis of the pubis has scarcely been reported as a complication following urological procedures- prostatectomy, sling surgery and catheterisation. We report a rare complication of a gentleman post radiotherapy presenting with delayed osteomyelitis of the pubis following supra-pubic catheterisation.

Incidentalology: A developing urological sub-specialty

OBJECTIVE

To identify the incidence and features of significant incidental findings discussed at our departmental multidisciplinary team meeting (MDM). The improved quality of radiological imaging has resulted in increased rates of incidental findings. Although some may be trivial, many have clinical significance and early diagnosis and treatment may be beneficial.

METHODS

A retrospective analysis was performed of all cases discussed at the MDM between January 2012 and February 2013. Cases were divided into two groups--Group 1 consisted of patients whose initial imaging was performed for a urological presentation which resulted in a synchronous finding; Group 2 consisted of patients who were referred with a synchronous urological finding for discussion following investigation of an initial benign urological condition or a non-urological condition.

RESULTS

696 patients were discussed at 53 MDMs. 109 (15.7%) patients had incidental findings. 61 (56%) of these were in Group 1. 16 (26.2%) were synchronous malignant diagnoses, 25 (41%) were benign and 20 (32.8%) were indeterminate. 48 (44%) patients in Group 2 - 40 (83.3%) were renal in origin and 30 (75%) of these proceeded to surgery. The median tumour size was 3.2 cm (Range: 1.2 cm-10 cm). One patient had radio-frequency ablation. Two were referred for palliative care. Seven patients are under ongoing surveillance--the median size of these lesions is 3.6 cm (Range: 2.1 cm-8.3 cm).

CONCLUSION

A substantial workload is generated from the investigation of incidental findings discussed at MDM--these now represent the majority of the caseload for renal cancer surgery.