Images – Penile pain in the setting of end-stage renal disease: An unusual anatomic location for calciphylaxis

In this report, we present a case of penile calciphylaxis, an extremely rare and serious condition occurring in association with dysregulation of systemic calcium metabolism in the setting of chronic renal impairment. Calciphylaxis can occur at various body sites and is associated with diffuse vascular calcifications in small and medium-sized arteries of the involved tissues. Penile calciphylaxis has a grim prognosis. Calciphylaxis is an important etiologic differential diagnosis for penile necrosis and penile pain in patient’s being treated with dialysis for end-stage kidney disease. Diagnosis of penile calciphylaxis is possible via clinical and radiological evaluations. Medical management may alleviate symptoms; however surgical interventions may be necessary, and histological studies may allow for definitive classification.

Sexual rehabilitation with intracavernous alprostadil after radical prostatectomy: Outcomes from a nursing program

Introduction and objectives: Erectile dysfunction (ED) is a common complication after radical prostatectomy that affects quality of life. There are several therapeutic options, including intracavernous alprostadil injections (IAI). However, no specific recommendations have been made on the optimal rehabilitation strategy. In this study we evaluated a sexual rehabilitation program (SRP) with IAI for patients with ED after radical prostatectomy, assessing the rate of compliance and reasons for dropout.Methods: The sexual rehabilitation program (SRP) was offered to all patients who underwent radical prostatectomy from 1 January 2010 to 31 December 2019. The first consultations were performed by a urology specialist nurse, explaining the IAI procedure and possible complications. The program was considered successful when the patients achieved autonomy in the drug preparation with a good injection technique. A medical consultation was performed at 6 months evaluating the IAI usage and adverse events. In case of dropout, a questionnaire about reasons for dropout was performed. The primary endpoint was the rate of compliance and dropout of the program. Secondary endpoints were the reasons for dropout and adverse events. Results: 340 patients underwent radical prostatectomy at our institution, and 123 patients accepted to participate in the rehabilitation program. A total of 96 patients (78%) successfully completed the SRP, and at 6 months 60 (62.5%) still used IAI. Concerning the reasons for dropping out, the most frequent were the need of injectable therapy and pain. Regarding complications, 17 patients (13.8%) reported pain related to the injection and 1 patient (0.8%) had a priapism, managed with conservative treatment. Conclusions: Management of post-radical prostatectomy ED by a nursing program achieved good rates of patients’ self-injection accomplishment and treatment compliance. Close monitoring for dose adjustment and management of post-injection penile pain is required during the follow-up.

Giant urethral stone with diverticulum; a case report

Urethral calculi are rare and represent 1-2% of all urinary stone diseases. Rarely, calculus grows to large size and are labeled as a "giant urethral calculus". A 75-year-old male came to the OPD of Madinah Teaching Hospital Faisalabad with a chief complaint of suprapubic pain, penile pain, and hard mass on the left side of the scrotum and anterior perineum. The patient had a significant history of undergoing debridement for Meleney's and Fournier's gangrene, along with suprapubic cystostomy done about 1.5 years back. Physical examination revealed a solid mass with dimensions 6x7 cm on the left side of the scrotum and anterior perineum (left periurethral area). Open surgery was performed. A huge stone, 6x6cm, was removed. Diverticulae were excised, and urethroplasty was performed. A catheter was removed on the 21st postoperative with a satisfactory urinary stream.

Impacted Ring in the Penis: A Crisis Rescued by Plier

A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real emergency uncommonly faced by a urologist. Emergent removal of the penile ring is indicated to prevent gangrene and damage to the penis. The insertion of these rings for autoerotic purposes is not uncommon. However, this can lead to impacted, stuck articles, rings in the penis. These patients present with symptoms ranging from mild penile pain, swelling to gangrenous changes in the penis. The removal of ring constricting penis is a penile-saving procedure. We describe a patient with a stuck ring in the penis and the technique of removal of the impacted penile ring by a household device plier. In case of emergency, the pliers are a useful tool for removing a strangulating penile ring

Deep dorsal penile vein thrombosis in a patient with Covid-19 Infection: A rare complication and the first reported case

Covid-19 infection may have extrapulmunary manifestations such as blood hypercoagulability that may causes thrombosis in both arterial and venous system.Deep dorsal penile vein thrombosis is very rare and the most common cause is coagulation disorders.It causes penile pain especially during erection and it is diagnosed by ultrasound.

Presentation of Psychosis Subsequent to Penile Injection of MDMA in a 60-year-old Patient-A Case Report

The street drug Molly, the crystal or powder form of MDMA (3,4-methylenedioxymethylamphetamine) is commonly ingested via oral or pulmonary routes. Intravenous administration of MDMA is rare and here we report a case of penile dorsal vein injection of Molly, development of penile abscess, and subsequent psychotic symptoms in a patient with a history of polysubstance use. A 60-year-old Caucasian male was presented to the psychiatric hospital with a chief complaint of hallucinations and homicidal and suicidal ideation following reported use of MDMA. Three days into his hospitalization, he began to experience sever penile pain and upon interviewing disclosed penile injection of MDMA prior to admission. Examination revealed a 1.5 X 0.7 cm abscess with minimal drainage and surrounding erythema on the body of the penis. The treatment course consisted of three days of intramuscular ceftriaxone and six days of oral Minocycline. In this case report, we discuss the challenges and importance of obtaining a thorough history for patients presenting with IV drug use as well as considering uncommon routes of administration.