Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-05 DEGREE OF HYDRONEPHROSIS AFTER UPPER TRACT RECONSTRUCTION PREDICTS NEED FOR REINTERVENTION Benjamin Cedars, Nishant Garg, Aaron Scheffler, Kian Ahmadieh, Dhruv Prui, Michael Witthaus, Eric Cho, Sunchin Kim, Thomas Fuller, and Jill Buckley Benjamin CedarsBenjamin Cedars , Nishant GargNishant Garg , Aaron SchefflerAaron Scheffler , Kian AhmadiehKian Ahmadieh , Dhruv PruiDhruv Prui , Michael WitthausMichael Witthaus , Eric ChoEric Cho , Sunchin KimSunchin Kim , Thomas FullerThomas Fuller , and Jill BuckleyJill Buckley View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nuclear medicine scans are commonly obtained within the first year after upper tract reconstruction to evaluate for resolution of obstruction. Renal ultrasound may suffice as a screening surveillance study to mitigate costs and risks of functional imaging when clinical suspicion for failure is low. We hypothesize that less severe hydronephrosis on post-operative imaging will have a lower risk of repeat intervention compared to worse severity. METHODS: We conducted a retrospective analysis of an institutional database on upper tract reconstructive surgery. Clinical variables were abstracted from the EMR. SFU grades (0,1,2,3,4) were assigned for degree of hydronephrosis. Patients with<1 year follow-up or aborted procedures were excluded. We utilized STATA (StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC) to perform logistic regression with raw SFU scores for pre-operative and 3- and 12-month post-operative hydronephrosis. RESULTS: There were 144 operations performed in 136 patients. There were 12 repeat interventions: 1 stent, 4 percutaneous nephrostomy tubes, and 7 reconstructive operations or nephrectomies. Only 1 patient with improvement on ultrasound at 3 months ultimately required repeat intervention. Seventeen patients demonstrated continued improvement from 3 to 12 months compared to two were worse, one of whom underwent repeat reconstruction. Prior to surgery, a one unit increase in SFU grade was associated with a 1.38 times greater odds (p=0.342, 95 % CI: [0.71, 2.70]) of repeated intervention. At 3 months following surgery, a one unit increase in SFU grade was associated with a 1.91 times greater odds (p=0.030, 95 % CI: [1.07, 3.42]) of repeated intervention. At 12 months following surgery, a one unit increase in SFU grade was associated with a 2.81 times greater odds (p=0.010, 95 % CI: [1.29, 6.16]) of repeated intervention. CONCLUSIONS: Patients with high post-operative SFU grades are at greater risk for reintervention. Severity of hydronephrosis post-operatively may be associated with need for repeat procedure; this association gets stronger from 3 to 12 months after reconstructive surgery. All but one patient with initial improvement continued to do well and did not require another intervention, suggesting ultrasound can help identify potential failures while avoiding unnecessary testing. Further studies will evaluate influence of symptoms and renal function. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e773 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin Cedars More articles by this author Nishant Garg More articles by this author Aaron Scheffler More articles by this author Kian Ahmadieh More articles by this author Dhruv Prui More articles by this author Michael Witthaus More articles by this author Eric Cho More articles by this author Sunchin Kim More articles by this author Thomas Fuller More articles by this author Jill Buckley More articles by this author Expand All Advertisement PDF downloadLoading ...