V07-07 Unforeseen Outcome in Hydrocele Repair: Implications of Three-Piece Inflatable Penile Prosthesis Placement

You have accessJournal of UrologySexual Dysfunction/Infertility/Andrology (V07)1 May 2024V07-07 UNFORESEEN OUTCOME IN HYDROCELE REPAIR: IMPLICATIONS OF THREE-PIECE INFLATABLE PENILE PROSTHESIS PLACEMENT Ali Pasyar, Matthew Megson, Parth Tadgiwala, Tobias S. Kohler, David J. Ralph, and Wai Gin Lee Ali PasyarAli Pasyar , Matthew MegsonMatthew Megson , Parth TadgiwalaParth Tadgiwala , Tobias S. KohlerTobias S. Kohler , David J. RalphDavid J. Ralph , and Wai Gin LeeWai Gin Lee View All Author Informationhttps://doi.org/10.1097/01.JU.0001008932.49144.fd.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Two months after an infrapubic penile prosthesis (IPP) insertion abroad, a 53-year-old gentleman presented to University College Hospital services with an unsupported flaccid shaft when the prosthesis was inflated and a right hemi scrotal bulge which enlarged with activity. MRI imaging identified a hydrocele around the prosthesis pump. This case report aims to describe the surgical correction of this presentation and identify its underlying cause. METHODS: This video outlines the operation. The procedure began with a transverse penoscrotal incision and dissection of the dartos muscle. The initial corporotomy allowed for the removal of the first prosthesis cylinder. Removing the right cylinder exposed turbid hydrocele fluid. 150 ml of turbid fluid was aspirated for microbiology testing. Next, the left cylinder was removed, followed by 7.5 cm of rear-tip extenders (RTEs), with additional RTE removal on the right using a nasal speculum. Thus, a 20 cm IPP with 7.5 cm RTEs on each side was extracted. Multiple Rifampicin/Gentamicin antibiotic washes were performed. A 26 cm+1 cm (13 mm) malleable prosthesis was inserted. The previous infrapubic wound was reopened to remove the reservoir, aspirating a further 75 ml of turbid fluid situated around it. Identifying a possible fistula via flexible cystoscopy revealed a normal urethra, bladder neck, and bladder, with no evidence of an abdominal cavity or urethral fistula. Methylene blue and distention found no bladder leak initially. However, with bladder filling, fluid drainage from the penoscrotal incision indicated a probable fistula diagnosis, connecting bladder erosion and the reservoir, tracing along the reservoir tubing to the right hemi scrotum and the penile prosthesis pump. RESULTS: The patient underwent replacement of the inflatable penile prosthesis with a malleable prosthesis, insertion of a suprapubic catheter, and drainage of the hydrocele. Recovery from surgery was smooth, with examination indicating proper seating of the prosthesis in the glans. Microbiological culture of the fluid did not yield any organism growth. A subsequent cystogram showed no signs of bladder leaks. The patient expressed satisfaction with the outcome and underwent a catheter trial with a planned review for exchange to an inflatable device. CONCLUSIONS: The presence of a hydrocele, without infective symptoms, suggests a contained urine leak or possibly a missed bladder injury from the initial prosthesis insertion. However, no fistula was discovered during the surgery or post-operative cystogram. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e469 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ali Pasyar More articles by this author Matthew Megson More articles by this author Parth Tadgiwala More articles by this author Tobias S. Kohler More articles by this author David J. Ralph More articles by this author Wai Gin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...