A. Traficante

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).

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) ≤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 ≤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 ≤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.

Obstetric and gynecological lesions of the ureter: Experience with 88 injuries

Over the past 17 years, 65 patients have been treated in our department for a total of 88 obstetric and gynecological ureteral lesions. Bilateral injury was involved in 23 cases. Conservative treatment was used in 13 injuries, diverting procedures in 8, nephrectomy in 5, and various surgical reconstructive techniques in 45. Seventeen patients refused therapy.An evaluation of the data shows that significantly better results were obtained when treatment was immediate (92%) than in cases in which treatment was purposely delayed (48%). Furthermore, in the latter group both nephrectomy and definitive diverting procedures were carried out in larger numbers. For optimal results, ureteral lesions must be repaired as soon as they are diagnosed, as long as the general condition of the patient permits.

Epidermoid cyst of the coronal sulcus mimicking penile cancer: a case report

IntroductionEpidermoid cysts represent common benign tumors occurring anywhere in the body but very rarely in the penis. Only a few cases of penile localization have been reported in the literature so far, most of them being congenital and/or idiopathic, usually presenting in children as slow-growing, solitary, well-delimited cystic lesions. Here, we describe the case of a patient with a penile epidermoid cyst presenting as an ulcerated lesion of the coronal sulcus, thus mimicking penile cancer.Case presentationA 36-year-old Caucasian man presented with a three-month history of a rapidly growing asymptomatic ulcerated lesion in the ventral portion of the penile coronal sulcus. At surgical exploration, the area under the ulcerated lesion had a well-demarcated cystic shape; following its wide excision, an intraoperative histological examination revealed an epidermoid cyst. No recurrence had occurred at nine years of follow-up.ConclusionsRare benign tumors of the penis, like the described epidermoid cyst, may mimic cancer. Nevertheless, penile ulcerated lesions should always be surgically explored as wide excision and intraoperative histological examination remain the only means of obtaining a precise disease definition and, consequently, administering the appropriate treatment.

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.