ORCID Profile
0000-0001-6739-6052
Current Organisation
NSW Health
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Publisher: MRE Press
Date: 2023
Abstract: Penile fractures are an uncommon urological emergency, typically diagnosed on clinical grounds and require urgent operative intervention. Examination findings include penile swelling and bruising, commonly referred to as an “eggplant deformity”. Close palpation to identify the exact site of injury is often limited by pain. Subcoronal degloving, often with concurrent circumcision is the most utilised surgical approach, though risks include skin necrosis and decreased penile sensitivity. Magnetic Resonance Imaging (MRI) for penile fracture diagnosis is increasingly recognised, however, its ability to guide localised longitudinal incisions is currently undefined. A multi-centre retrospective observational study from February 2016 to February 2022 was performed. Electronic medical records were reviewed for patient demographics, presentation, injury characteristics, investigations and operative outcomes. MRI use and protocols were determined at the discretion of the treating urologist and on-duty radiologist respectively. Twenty-one patients were eligible for study inclusion. Ten patients underwent pre-operative MRI. Median time from MRI request to image acquisition was 2.5 hours (1.5–3.0). Time from presentation to surgical intervention did not significantly differ between the two groups. All patients without pre-operative MRI underwent subcoronal degloving. Six patients underwent MRI-guided localised incision successfully without requiring secondary incision or conversion to subcoronal degloving. The remaining four patients in the MRI cohort underwent degloving. Operative times were significantly shorter (p = 0.44) in the pre-operative MRI group, with a median duration of 1.11 hours (0.98–1.17), compared to 1.5 hours (1.20–1.75) in the non-MRI cohort. Median length of stay was 1 day in both groups. No Clavien Dindo 2 or greater complications were observed in any patient. In this study, MRI in the pre-operative setting for penile fractures is associated with reduced operative time and was successfully used to guide localised incisions for direct repair of penile fractures. Its use has the potential to change the paradigm of penile fracture management and operative repair.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2021
DOI: 10.1186/S12894-021-00878-5
Abstract: Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support. A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission. This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.
Publisher: SAGE Publications
Date: 18-07-2019
Abstract: Endoscopic upper urinary tract instrumentation is a common urological procedure often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b
Publisher: Wiley
Date: 11-04-2023
DOI: 10.1002/TRE.912
Abstract: Erectile dysfunction is more common than realised and can be the first indication of systemic disease. Penile prosthesis is a low‐risk intervention with high patient satisfaction, previously deemed an endstage form of management. However, improvements in the devices and a recent American Association of Urology recommendation could change that.
Publisher: Wiley
Date: 11-2022
DOI: 10.1002/TRE.886
Abstract: Nocturia is a common and often bothersome lower urinary tract symptom. Interestingly, nocturia, although intuitively classified as a lower urinary tract symptom, may be non‐intuitively due to a variety of other causes. Similarly, investigation and treatment may be urological or even more commonly, non‐urological. This article aims to outline a systematic and considered approach to the assessment and management of nocturia.
Publisher: AME Publishing Company
Date: 05-2023
DOI: 10.21037/TAU-22-759
Publisher: SAGE Publications
Date: 12-08-2011
Publisher: Galenos Yayinevi
Date: 09-2023
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 03-2023
No related grants have been discovered for Ankur Dhar.