Penile fracture is a rare urological emergency that always requires immediate attention. It may be associated with urethral trauma in 9% to 20% of cases. We present our experience in treating 12 such cases. This is a prospective observational study extending from January 2000 to December 2016. Each patient with penile fracture underwent a thorough clinical evaluation and received proper treatment. Seventy-five patients with penile fracture, aged 25 to 36 years (mean, 31.5 years) were evaluated in this study. Sexual intercourse was the common mechanism of injury in most of the patients. 12 of the patients had associated urethral injury. All the patients were diagnosed on taking proper history and after clinical examination. All patients were subjected emergency surgical exploration. All the patients underwent minimum of 1 year of follow-up, and were evaluated with local examination, uroflowmetry and Colour Doppler ultrasonography. Penile fracture is associated with urethral injury especially in the presence of suggestive history and physical examination like acute urinary retention, bleeding per urethra. Immediate primary surgical management of both the penile fracture and urethral injury is a safe and effective option with minimal complications.
Objective: To present our stepwise approach to the management of penile strangulation and penile preservation with 15 years’ experience in a tertiary care hospital, as penile strangulation is a rare urological emergency that requires immediate attention.Patients and methods: A prospective observational study was performed from March 2003 to December 2018 of patients presenting with penile strangulation to our hospital.Results: Nine patients with penile strangulation presented to us between March 2003 and December 2018. The most common motive for the application of a foreign body was sexual gratification (four patients). Three of the nine patients had a mental disorder. Objects used for strangulation included: metallic nut (three), metallic ring (two), plastic bottle (two), wooden hole (one), hammer head (one), and horse hair to control bleeding during circumcision (one). Most of the foreign bodies were located in the proximal penile region. The mean operative time was 38 min and three of the nine patients had complications.Conclusions: Penile strangulation is one of the rare urological emergencies experienced by a urologist. Removal of the foreign body can be difficult and there is no universal method of removal, as each case differs. So, following our stepwise approach can aid in removal of foreign body quickly and preserve the penis from fatal outcomes. Urologist should be aware of all the available armamentarium used for the removal of such foreign bodies.Abbreviation: SPC: suprapubic cystostomy
To evaluate the presentation and diagnostic criteria of emphysematous pyelonephritis and different modalities of their management at our instititute. Methods: A prospective study of 5 years in which patients who were diagnosed to have emphysematous pyelonephritis confirmed by a non contrast CT presenting at our centre were included in this study and baseline information, a brief clinical history with a written consent was collected from each patient. The course of the patient along with investigations and interventions done from admission were recorded. Results: 72 patients were included in this study with a mean age of 55.4 +/-12.1 years (30 to 75 years), comprising of 47 females and 25 males. Common presentation was tachycardia (94.5 %) and fever associated with burning micturition (75.3%) followed by loin pain on the affected side (71%). 31 cases which formed a majority were diagnosed to have right sided emphysematous pyelonephritis (41.9%), 28 had left sided (38.35%) and 14 bilateral (19.17%) in our series. 90.41 % of the patient were diagnosed to have diabetes mellitus of which 34 patients (46.57 %) presented with high sugars. Urine cultures were positive in only 41% of the patients with the most common organism being E. coli (68%) followed by Klebsiella pneumoniae (14%). 64.8% of the patients diagnosed were treated conservatively with IV antibiotics and 34.24% by endoscopic management. Conclusions: In this study we have shown that a medical line of management with appropriate endoscopic intervention is the present choice of management of emphysematous pyelonephritis irrespective of the CT grade of the disease. Level of evidence: Not applicable for this multicentre audit.
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