Management of severe complications following penile surgery for erectile dysfunction and Peyronie disease: Three case reports.

Abstract:

RATIONALE:Erectile dysfunction (ED) and Peyronie's disease (PD) are conditions commonly observed in andrology. Despite the surgical refinement and the technical improvement in this field, even in expert hands, detrimental consequences have been reported and it can be related to patient's comorbidities or misconduct in the postoperative period. In this article we report anecdotal cases of severe complications following penile surgery for ED and PD in high volume centers, describe the strategies adopted to treat it and discuss the options that would have helped preventing these events. PATIENTS' CONCERNS:The first case describes a patient with history of ED and PD causing penile shortening and a slight dorsal deviation of penile shaft. In the second case it is described a corporeal necrosis and urethral fistula following inflatable penile prosthesis implant. In the last case it is described the migration of reservoir into the abdomen after inflatable penile prosthesis implantation post-radical prostatectomy. DIAGNOSIS:All 3 patients were investigated with a penile doppler ultrasound with PGE1 intracorporeal injection for ED and PD diagnosis. An abdominal computed tomography scan and magnetic resonance imaging were ordered for patient of case three. INTERVENTIONS:The patients underwent different combined procedures depending on the case and including: glansectomy, penile prosthesis implantation associated with a penile elongation with double dorsal-ventral patch graft ("sliding technique"), penile urethroplasty with buccal mucosa graft, and laparotomy for reservoir removal. OUTCOMES:No further serious complications were reported after the procedures described. LESSONS:Penile surgery in patients with concomitant PD and systemic comorbidities can be at high risk of complications. As shown in this series there are possible dramatic evolution of these complications that may cause irreversible consequences to the patient. For this reason, a dedicated surgical and nursing team is necessary to reduce the chances that it happens. When this event occurs, a team trained in their management can improve the patient outcome.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Bettocchi C,Santoro V,Sebastiani F,Lucarelli G,Colombo F,Ralph DJ,Habous M,Ditonno P,Battaglia M,Spilotros M

doi

10.1097/MD.0000000000018690

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

e18690

issue

7

eissn

0025-7974

issn

1536-5964

pii

00005792-202002140-00006

journal_volume

99

pub_type

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