This review highlights the controversies regarding prosthetic materials, the complications of insertion and the potential benefits of this commonly performed procedure.

Ann RC oll Surg Engl 2009; 91:5 32-534 532Bleeding per urethram is ac ommon urological symptom which prompts urgent investigation, aimed primarily at excluding malignancy.T he differential diagnosis in these patients is considerable. We present three cases of urethral bleeding associated with post-coital ejaculation that was found to be caused by urethral venous malformations, a condition that is rare but probably under-reported. Patients and MethodsThe case notesofthree patients who wereidentified as suffering from post-coital urethral bleeding were reviewed. Due to the rarity of the disease and the lack of standardisation in the diagnosisa nd treatment, personal communication withe ach surgeon was necessary for am ore accurate descriptiono ft he intra-operativefindings and details of the surgical treatment. A search and reviewo ft he literature publishedi nE nglish was performed using the PubMed database. ResultsThe three patients in this series were treated by three different urological surgeons, all practising in the same unit. Cases are reported both separately and in comparison (Table 1). Case report 1A5 8-year-old man represented to the department of urology in 2007 with ah istory of haematospermia and haematuria spanning 20 years. The patient reported that episodes of haematospermia and haematuria were provoked by ejaculation. He was first investigated for frank haematuria 18 years previously when it was reported that there was no abnormality of the urinary tract. He was re-investigated for haematuria 10 years later when large 'varicose veins' were noted in the bulbar and membranous urethra, coursing over the external sphincter muscle. Three years previously, he was again referred complaining of haematuria. On this occasion, af lexible cystoscopy was reported as normal. Over the next 2y ears, the patient was admitted to hospital on three occasions with further episodes of heavy haematuria and the passage of clots. Investigations including an intravenous urogram, renal/pelvic ultrasound scan and magnetic resonance imaging (MRI) of the pelvis were reported as normal. His most recent cystourethroscopy, however,demonstrated large, abnormal branching veins in the bulbar urethra (Fig. 1) on either side of the verumontanum and around the bladder neck. In addition, within the bladder there were abnormal sub-mucosal veins high on the posterior bladder wall. Judicious 'spot-welding' of these veins at the bladder neck, alongside the verumontanum and in the bulbar urethra was performed using diathermy coagulation. At 6-month review,t he patient was free of postcoital haematospermia and haematuria for the first time in 20 years. Case report 2A4 1-year-old man was referred with a1 0-year history of intermittent haematuria with clots. This had always been associated with sexual activity and ejaculation. There was CASE REPORTS

Two consecutive randomized trials following injection sclerotherapy for varicose veins compared 3 and 6 weeks bandaging in 148 patients and 1 to 3 weeks bandaging in 130 patients. Objective assessment and patient's symptoms, using a scoring system, correlated well and showed that there was no difference whatsoever between 3 and 6 weeks' bandaging after a 6 year follow-up. In the second trial, the patients who were bandaged for 3 weeks were significantly better (P < 0.001) than after only one week of bandaging at a maximum follow up of 4 years. Long term follow up of injection sclerotherapy for primary varicose veins suggests that 3 weeks is superior to 1 week bandaging, but that there is no additional advantage in continuing bandaging for six weeks.

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Ann R Coll Surg Engl 2006; 88: 343-348 343Penile implants have been used for the treatment of erectile dysfunction for over 30 years. Initial results were far from excellent due to both mechanical problems and the dreaded complication of infection. Improved outcomes have been achieved in recent times due both to improved surgical care and also developments in device manufacture. The role of penile prostheses has been discussed previously.1 This review will concentrate on describing the most recent advances in this field. Literature searchA Medline search was carried out using the search terms 'penile prosthesis' and 'penile implants'. The reference lists of key articles were also reviewed. Articles published since 2000 that reported a modification of prosthesis design or surgical technique were chosen in order to ensure that the review reflected current practice. Implant types and improvements in implant mechanicsThe main categorisation of penile implants is between inflatable and non-inflatable devices.The non-inflatable devices are semi-rigid and may be silicone malleable rods (Fig. 1) or a series of articulating polyethylene discs with a central metal cable support. Noninflatable implants are relatively cheap and easy to insert with few mechanical complications. However, they provide a less than ideal result both in terms of cosmesis/concealment and quality of erection.Inflatable implants aim to reproduce normal function as much as possible in both allowing penile flaccidity when not in use and subsequent girth/length expansion during The treatment of erectile dysfunction has been revolutionised with the introduction of orally active phosphodiesterase inhibitors which are successful in 70-80% of men. However, there remain a group of men in whom conservative treatment fails and surgical insertion of a penile prosthesis is required. This type of surgery has in the past been associated with technical difficulties and a high complication rate. This has spurred numerous developments in prosthesis design and surgical technique with the field changing at a rapid pace. Perhaps the most significant is the use of antimicrobial coatings on prostheses that have been shown to reduce the infection rate significantly. This review highlights those developments reported in the last 5 years.