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Radical cystectomy can be a morbid operation [...]

This case report presents the first use of Optilume® drug-coated balloon (DCB) technology for the management of post-transurethral resection of the prostate bladder neck contracture (BNC), a condition often resistant to traditional treatments. A 62-year-old male with recurrent BNC, unresponsive to multiple operative interventions, underwent treatment with the Optilume® DCB, resulting in significant symptom resolution without further invasive procedures. This novel application of DCB technology, delivering paclitaxel directly to the affected tissue, offers a promising alternative by targeting the underlying pathophysiology of BNC.

Penile fractures are an uncommon urological emergency, typically diagnosed on clinical grounds and require urgent operative intervention. Examination findings include penile swelling and bruising, commonly referred to as an “eggplant deformity”. Close palpation to identify the exact site of injury is often limited by pain. Subcoronal degloving, often with concurrent circumcision is the most utilised surgical approach, though risks include skin necrosis and decreased penile sensitivity. Magnetic Resonance Imaging (MRI) for penile fracture diagnosis is increasingly recognised, however, its ability to guide localised longitudinal incisions is currently undefined. A multi-centre retrospective observational study from February 2016 to February 2022 was performed. Electronic medical records were reviewed for patient demographics, presentation, injury characteristics, investigations and operative outcomes. MRI use and protocols were determined at the discretion of the treating urologist and on-duty radiologist respectively. Twenty-one patients were eligible for study inclusion. Ten patients underwent pre-operative MRI. Median time from MRI request to image acquisition was 2.5 hours (1.5–3.0). Time from presentation to surgical intervention did not significantly differ between the two groups. All patients without pre-operative MRI underwent subcoronal degloving. Six patients underwent MRI-guided localised incision successfully without requiring secondary incision or conversion to subcoronal degloving. The remaining four patients in the MRI cohort underwent degloving. Operative times were significantly shorter (p = 0.44) in the pre-operative MRI group, with a median duration of 1.11 hours (0.98–1.17), compared to 1.5 hours (1.20–1.75) in the non-MRI cohort. Median length of stay was 1 day in both groups. No Clavien Dindo 2 or greater complications were observed in any patient. In this study, MRI in the pre-operative setting for penile fractures is associated with reduced operative time and was successfully used to guide localised incisions for direct repair of penile fractures. Its use has the potential to change the paradigm of penile fracture management and operative repair.

A case report describing the surgical challenges of an open approach bilateral T3b renal cell carcinoma with bilateral renal vein involvement. This is the second reported case of bilateral renal cell carcinoma with extension into bilateral renal veins and inferior vena cava. This case highlights how good outcomes can be achieved with open surgical approach.

Self-inserted urethral foreign bodies are an unusual albeit well documented phenomena and cause of hospital presentation. When conservative non-operative managements fail, operative management is imperative to prevent further complications including infection, stones, diverticula, and fistula formation. Minimally invasive alternatives should be considered when cystoscopic access to the foreign body is mechanically difficult. Through this case presentation, we showcase a novel technique to consider when dealing with intraurethral foreign bodies - the use of thulium laser with rigid ureteroscope. We believe this to be the first documented case of successful intraurethral foreign body fragmentation using thulium laser.

Background: Sacroneuromodulation (SNM) is a technique that simulates sacral spinal nerve roots with the goal of modulating afferent neural pathways. While the exact mechanism of effect is incompletely understood, it is an effective treatment in several pelvic floor disorders including Overactive Bladder (OAB), voiding dysfunction and non-obstructive urinary retention. The placement of SNM leads is guided by fluoroscopy or anatomical landmarks. The preferred target is the S3 sacral nerve. Correct placement is confirmed through obtaining the desired motor responses of anal bellows and toe dorsiflexion. Objective: To demonstrate our operative technique for SNM lead placement, including theatre set-up, use of fluoroscopy, identification of relevant anatomical landmarks and the novel use of an in-line camera to guide lead placement. Additionally, we demonstrate the motor findings associated with the target S3, and inadvertent S2 nerve stimulation. Patient and Surgical Procedure: We routinely perform basic evaluation trials for confirmation of symptomatic improvement (50% or greater), prior to single stage system implantation. We utilise the Medtronic Interstim device (Minneapolis, MN). Fluoroscopy and an additional in-line camera are used to guide all lead insertions. Confirmation of correct lead placement is achieved through visualisation of the desired motor responses. Additionally, stimulus amplitudes of less than 2 Vs are desired. Results: The use of an in-line camera acts as an additional reference point, allowing the operator to maintain an optimal craniocaudal angle during needle insertion. This is particularly useful in patients with a high BMI, where operator vision is limited, and early in the learning curve for trainees. Motor findings associated with both inadvertent S2, and the target S3 nerve stimulation are also demonstrated in a real-time case. Conclusion: Fluoroscopy and the use of an in-line camera allows for efficient SNM lead placement into the S3 sacral foramen.

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Prone ventilation is an effective and increasingly utilised tool in the management of Acute Respiratory Distress Syndrome (ARDS), a common sequela of COVID-19 infection. However, its use is associated with a significant risk of pressure ulcers.We report a unique case of prone positioning, catheter-related penile pressure ulcer. Clinical awareness, early recognition and regular repositioning is crucial in the prevention of this complication.

Ischemic priapism is a urologic emergency requiring urgent intervention to prevent tissue necrosis and preserve erectile function. Cases refractory to aspiration and intra-cavernosal sympathomimetic therapy requires timely surgical shunting. Corpus cavernosum abscess following penile shunts is an exceedingly rare complication, with as few as 2 previous reported cases.We report our experience and outcome in the case of a 50-year-old patient who developed a corpora cavernosum abscess and concurrent corporoglanular fistula, following penile shunt procedures for ischemic priapism.

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Abstract Background Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support. Case presentation A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission. Conclusion This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.