Salvage Procedure in Case of Urethrocavernous Fistula after Revision Surgery for Malfunctioning Three-Piece Penile Prosthesis

Caraceni, E.; Marronaro, Angelo; Leone, Luca

doi:10.1155/2016/4179862

Cited by 7 publications

(6 citation statements)

References 11 publications

(12 reference statements)

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“…Given the risk of fistula formation in catheter-dependent patients, some have reported performing perineal urethrostomy or suprapubic cystotomy at the time of penile prosthesis surgery [11]. Caraceni et al reported a case of urethrocavernous fistula with successful IPP replacement, primary repair of urethral and cavernosal defects augmented by the use of a dry layer of the human coagulation factors fibrinogen and thrombin [12]. Given the paucity of cases of urethral erosion and urethrocavernous fistula secondary to penile prosthesis, no standard of care has been established.…”

Section: Discussionmentioning

confidence: 99%

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

2021

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Background Urethral injury or erosion of an inflatable penile prosthetic (IPP) cylinder is a rare complication of IPP placement. It can present with varying symptoms and management can be difficult with risk for future complications. We present a patient with an eroded IPP who developed a secondary contralateral urethrocavernous fistula requiring repeat urethroplasty. We also describe the literature surrounding these complications and strategies to prevent them. Case presentation A 69-year-old man with poorly controlled diabetes presented to our clinic with 6 months of intermittent white urethral discharge first noted after IPP removal and replacement by an outside urologist for device malfunction. Office cystoscopy revealed an eroded right-sided prosthetic cylinder in the bulbar urethra. The patient was taken to the operating room for IPP explantation with closure of right corporal defect, left sided malleable prosthesis placement, and primary excision with anastomosis of his bulbar urethra. A catheter was left in place for two weeks postoperatively, at which time a peri-catheter retrograde urethrogram was performed which showed no evidence of contrast extravasation and his catheter was subsequently removed. Several months later, he presented with recurrent urethral discharge without evidence of recurrent erosion on cystoscopy with development of scrotal abscesses following office cystoscopy, concerning for an unidentified urethral defect. He returned to the operating room for scrotal exploration and was noted on cystoscopy to have a pinpoint fistula between his left corporal body and his bulbar urethra. He underwent left sided malleable prosthetic explant, and non-transecting bulbar urethroplasty. Peri-catheter retrograde urethrogram two weeks later showed no contrast extravasation and he has had no recurrence of urethral discharge or scrotal abscesses since. Conclusions Urethral erosion and urethrocavernous fistula formation are rare complications of penile prosthesis placement. Risks are elevated in patients with corporal fibrosis, diabetes, those undergoing penile implant revision surgery, and those requiring prolonged urethral catheterization.

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Section: Discussionmentioning

confidence: 99%

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

2021

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“…[1][2][3] However, blunt trauma, iatrogenic, and idiopathic causes have also been reported. [4][5][6][7][8][9] Patients usually had a delayed presentation of 2 to 5 weeks from the initial inciting event. 2,3,5,6,[8][9][10] Presenting symptoms included dysuria, purulent or foul-smelling urethral discharge, abscess on the penile shaft, or intermittent or pulsatile gross hematuria with erections.…”

Section: Discussionmentioning

confidence: 99%

“…Primary repair or repair with a fibrin seal patch (TachoSil®) or an allograft such as Tutoplast® pericardium has been reported previously with complete resolution. [5][6][7]10 Tachosil® was first described in the setting of pancreatic resections to prevent post-operative pancreatic fistulas. The efficacy of this material in this type of repair has been reported with variable success.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and management of urethro-cavernosal fistulas

Han

Ghodoussipour

Kreydin

et al. 2020

Journal of Clinical Urology

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Objective: To present a case series of urethro-cavernosal fistulas evaluating their diagnostic work-up and management. Methods: A literature search was performed using key words including “urethro-cavernosal fistula,” “urethral fistula,” and “cavernosal fistula.” Results: In total 10 case reports were identified and reviewed for information regarding clinical diagnosis, management, and long-term outcomes including success rates and complications. Conclusion: Urethro-cavernosal fistula is a rare urological condition. With few cases reported to date, there is considerable variation in diagnostic work-up and management. Both conservative and surgical approaches can be utilized in the management of urethro-cavernosal fistulas with good long-term outcomes. Level of evidence: Not applicable for this multicentre audit.

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“…The efficacy of the T-shunt and Al-Ghorab shunts can be improved to nearly 100% when combined with the use of dilators to physically remove stagnant blood within the corpora [ 16 17 18 ]. However, use of dilators is accompanied by an increased risk of urethral injury and possible formation of urethrocavernosal fistulas [ 19 ]. Should distal shunts fail, the use of proximal shunts is warranted.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Role of Penile Prosthesis in Priapism: A Review

Reddy

Alzweri

Gabrielson

et al. 2018

World J Mens Health

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Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

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Salvage Procedure in Case of Urethrocavernous Fistula after Revision Surgery for Malfunctioning Three-Piece Penile Prosthesis

Cited by 7 publications

References 11 publications

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

Diagnosis and management of urethro-cavernosal fistulas

Role of Penile Prosthesis in Priapism: A Review

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