Asymptomatic spontaneous migration of double pigtail ureteral stent outside the ureter.

We report a case of asymptomatic spontaneous migration outside the ureter of a double pigtail ureteral stent. This previously undescribed complication confirms the need for regular follow-up of patients with indwelling stents.

Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam.

OBJECTIVE: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). PATIENTS AND METHODS: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. RESULTS: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. CONCLUSIONS: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

Tunica albuginea plication for the correction of penile curvature.

OBJECTIVE: To evaluate the efficacy of tunica albuginea plication (TAP) in the correction of congenital and acquired penile curvatures and determine key points for a successful outcome of this procedure. MATERIALS AND METHODS: From December 1995 to January 2001, 40 patients with penile curvature (10 congenital and 30 secondary to Peyronie's disease) underwent surgical correction by TAP. Indications were difficult or impossible penetration, normal erectile function, stable disease. For TAP we used non-absorbable inverted stitches tied with the assistant pushing down the tunica albuginea with a mosquito clamp to create an adequate groove for the knot. The results were evaluated subjectively and objectively. RESULTS: At mean follow-up of 30 months, full subjective and objective success (straight penis, mild shortening, normal erection, penetration and sensation) was achieved in 37 (92.5%) patients. Objective but not subjective success was achieved in 2 patients (5%), 1 complaining of psychogenic erectile dysfunction and the other of excessive penile shortening. There was only one failure, namely persistent glans numbness due to damage of the non-mobilized neurovascular bundle. CONCLUSIONS: TAP is a simple and effective method for the correction of congenital and acquired penile curvatures. Key points for successful outcome are adequate preoperative evaluation and counselling, careful preparation of tunica albuginea, mobilization of urethra or neurovascular bundle when needed, use of inverted stitches carefully buried, objective postoperative evaluation with a pharmacological erection test.

Resistance index as a prognostic factor for prolonged erection after penile dynamic colour Doppler ultrasonography.

OBJECTIVE: To identify an objective and reliable prognostic factor for prolonged erection after penile dynamic colour Doppler ultrasonography (CDU). METHODS: From June 1995 to July 1996, 156 patients suffering from erectile dysfunction were submitted to penile dynamic CDU at our institution. From June to December 1995 (Group 1), patients with rigid erection at the end of the test were invited to wait 90 min for a review. If detumescence had not occurred at the first review, they were invited to wait another 60 min for a second review. If detumescence had not occurred at this stage, they were given an intracavernous injection (ICI) of etilefrin to induce detumescence. To test the validity of the findings obtained in Group 1, from January to July 1996 (Group 2) patients with rigid erection and resistance index (RI) < or = 1.00 at the end of penile dynamic CDU were sent home and invited to return to the hospital if erection lasted more than 2 h, while those with rigid erection and RI > 1.00 were immediately given an ICI of etilefrin to induce detumescence. RESULTS: Of the 62 patients in Group 1, 31 yielded a rigid erection. Seven refused to wait for a review. They were given an ICI of etilefrin and excluded from the study. Of the 24 evaluable patients, 10 presented spontaneous detumescence at the first review. RI was < or = 1.00 in 7, and > 1.00 in the other 3. None of the remaining 14 patients presented spontaneous detumescence at the second review. RI was > 1.00 in all of them. They were successfully managed with an ICI of etilefrin. Of the 94 patients in Group 2, 43 yielded a rigid erection. Twenty had a RI < or = 1.00 and therefore were sent home. None of them returned to the hospital. Contacted by phone, they all said that spontaneous detumescence had occurred within a couple of hours. Of the 23 patients with RI > 1.00, 22 were immediately given an ICI of etilefrin. One who refused returned to the hospital 4 h later with a prolonged erection which was successfully managed with an ICI of etilefrin. CONCLUSIONS: This study showed that RI is a reliable prognostic factor for prolonged erection. In patients with RI > 1.00 at the end of penile dynamic CDU, immediate prevention of prolonged erection is recommendable to avoid unpleasant sequelae.

[Role of echography in the diagnosis of urethral stenosis]. / Ruolo dell'ecografia nella diagnostica delle stenosi dell'uretra.

A recently developed ultrasonographic technique was described to evaluate the anterior urethra in 10 men suspected to have urethral stenoses. With the patient in frog leg position, during a perfusion of the urethra with saline through a catheter positioned at the beginning of the urethra, penile, transscrotal and transperineal scanning of the urethra was obtained. In all patients a diagnosis of urethral stenoses was made. After sonographic evaluation all patient underwent retrograde urethrogram and internal urethrotomy, that confirmed the diagnosis made by ultrasound. The urethral ultrasound provides valuable informations about the number, extent, position of the strictures and eventual scarring of the periurethral tissue. Urethral ultrasonography can be used as alternative imaging modality to the conventional radiological techniques.

[Role of dynamic penile color Doppler echography in the evaluation of the patient with La Peyronie's disease]. / Ruolo dell'ecocolor Doppler penieno dinamico nella valutazione del paziente con malattia di La Peyronie.

From March 1995 to February 1996, sixteen consecutive patients with Peyronie's Disease (PD) were routinely submitted to penile dynamic colour-coded doppler ultrasonography (CCDU). The test yielded normal results in 6 patients who had no erectile problems and in other 4 patients who conversely complained of reduced erectile function. In the other 6 patients who complained of reduced erectile function, the test pointed out pure arteriogenic failure in 1 case, pure venogenic failure in 4, and mixed arteriogenic and venogenic failure in 1. CCDU enables a precise assessment of erectile function as well of the site, kind and entity of the penile curvature to be corrected. These data are very useful when planning the surgical approach for each patient.

[Penile dynamic color Doppler echography in the diagnosis of erection disorders]. / Ecocolor Doppler penieno dinamico nella diagnostica dei disturbi dell'erezione.

Penile dynamic colour-coded doppler ultrasonography (CCDU) provides reliable information on both hemodynamic factors, arterial inflow and veno-occlusive mechanism, involved in erectile function. However false negative results may occur due to sympathetic discharge and consequent incomplete smooth muscle relaxation. From March 1994 to February 1996, 150 patients suffering from ED were submitted to penile dynamic CCDU after high-dose (40 micrograms) pharmacostimulation and manual genital stimulation. False negative results occurred only in 3 (2%) patients. This experience suggests that high-dose pharmacostimulation and manual genital stimulation may reduce the occurrence of false negative results, further increasing the diagnostic value of CCDU.