OCCULT RETAINED PENILE PROSTHETIC FRAGMENTS IN PERSISTENT UROGENITAL INFECTIONS

Abstract

Case 1. A 46-year-old black man with a history of T2a pros- tate cancer treated with radical retropubic prostatectomy un- derwent insertion of a penile prosthesis. This prosthesis was removed because of mechanical failure. The patient underwent 2 additional inflatable prosthesis implantations during the next 16 years, both of which explanted secondary to infection. Three months after the most recent explantation he noticed penile swelling and a rash over the scrotum. Evaluation elsewhere included contrast enhanced computerized tomography (CT) of the abdomen/pelvis as well as a skin biopsy. Diagnosis was Schonlein-Henoch purpura associated with a soft tissue phleg- mon of the anterior pelvis. There was no foreign body noted. The patient was referred to us 4 months later with the persistent complaints of intermittent discomfort and swell- ing of the entire penis, scrotum and suprapubic region. Non- enhanced CT of the pelvis using small cuts revealed a small foreign body near the peripheral aspect of the phlegmon in the scrotum (fig. 1). This finding was consistent with a re- tained segment of connecting tubing from a previously re- moved penile prosthesis. Surgical extirpation of the retained connecting tubing and phlegmon resulted in resolution of symptoms. Intraoperative ultrasound confirmed the absence of further retained foreign bodies. Intraoperative cultures yielded only rare Peptostreptococcus, while the gram stains revealed numerous white blood cells and gram positive cocci. Notably, the patient had been on broad-spectrum antibiotics preoperatively. Case 2. A 36-year-old black man with a history of recalci- trant erectile dysfunction underwent insertion of an inflat- able penile prosthesis. Mechanical failure required at- tempted revision and replacement of the prosthesis 1 year later. The new prosthesis became infected 11 months later and was removed. Four years later he underwent difficult reconstruction at a second medical center, which involved placement of a single cylinder into the right proximal crus crossing the midline into the left distal corporeal shaft. Op- erative notes indicated significant fibrotic changes.