Gross hematuria has several different etiologies, and as such, the process of working up a patient presenting with bleeding follows an outlined algorithm. The instillation of formalin, a caustic substance that hydrolyzes proteins and coagulates tissues, is a possible treatment option only when patients have failed previous preceding therapeutic steps. In our case, a 69-year-old African-American male presented with an acute episode of gross hematuria that did not resolve following several diagnostic and therapeutic steps. His hospital course was complicated by a steadily dropping hemoglobin, requiring many blood transfusions throughout his care. He was successfully treated with intravesical instillation of formalin following cystoscopy, transurethral resection of the prostate, and cystogram in the operating room. Thoughtful discussion regarding a treatment course in a patient with refractory gross hematuria deserves consideration.

Penile fracture (PF) required an early surgical exploration and defect closure of the lesions to prevent long-term complications. However, post-operative unsatisfactory penile curvatures are frequent in literature. In this study, we wished to present surgical outcomes of PF after surgical repair approach with an early intraoperative curvature correction, if needed, and update our series with post-operative follow-up. METHODS: We performed an institutional retrospective review study of patients (pts) undergoing surgical treatment for PF by a single surgeon at two tertiary academic referral center. Length of the tear was determined at the time of the repair. Only pts with at least 6 months of follow-up were included. All surgical explorations were performed within 12 hours of the traumatic event. The tunica defect was closed by a running suture of absorbable 3-0 polydioxanone with inverted knots. An artificial erection was induced by injection of sterile saline solution into the corpora cavernosa to determine the integrity of the suture and the degree of deviation. Penile plication was then performed to straighten the tunica angulations in all pts with curvature greater than 30 , using 2 to 3 pairs of 2-0 non-absorbable suture of polyester through the full thickness of the tunica albuginea. RESULTS: A total of 34 pts having PF of the corpora cavernosa were include in this review. Median age of pts was 54.3(26-74) years. Pts in the fifth decade (38.2%) were affected predominantly. All pts had singular tear of the corpora cavernosa. The length of the tear ranged from 8 to 20 mm. The defect was in the mid-shaft in 13 pts (38.2%) or proximal shaft in 21 pts (61.8%): 23 cases (67.7%) right side and 11 cases (32.3%) left side. After the tunica defect was closed by a running suture, 28 pts (82.4%), with an intraoperative curvature greater than 30 , required to correct the cavernous body deviation. A transurethral foley catheter was placed in all patients for 24 hours, except for 3 pts with urethral injury the foley catheter fixed for one week. No early complications occurred in any case. The mean follow-up was 20.8 (6-42) months. At follow-up all treated pts were satisfied overall with sexual intercourse; 3 pts reported residual pain and discomfort for the knots of the non-absorbable sutures. CONCLUSIONS: An early intraoperative curvature correction may be used for a variety of angulation deformities and severe degrees of deviations secondary to a repair after penile trauma, and may be helpful in preventing postoperative morbidity.