title: Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation.
abstract: BACKGROUND
  Urethral injury is an uncommon surgical complication of penile prosthesis (PP) surgery. Conventional dogma requires abortion of the procedure if the adjacent corporal body is involved or delayed implantation to avert device infection associated with urinary extravasation. Besides the setback of the aborted surgery, this management approach also presents the possible difficulty of encountering corporal fibrosis at the time of reoperation.
  
  
  OBJECTIVE
  We report an approach using primary urethral repair and temporary suprapubic cystostomy for the management of incidental urethral injuries in a cohort of patients allowing for successful completion of unaborted PP implantation.
  
  
  METHODS
  We performed a retrospective analysis of all patients receiving PPs from 1990 to 2014 in which incidental urethral injuries were repaired and PP implantation was completed with suprapubic cystostomy (suprapubic tube [SPT] insertion). After allowing for urethral healing and urinary diversion via SPT for 4-8 weeks, the PP was activated.
  
  
  METHODS
  Successful management was determined by the absence of perioperative complications within 6 months of implantation.
  
  
  RESULTS
  We identified four cases, all receiving inflatable PPs, managed with temporary suprapubic cystostomy. These patients sustained urethral injuries during corporal dissection (one patient), corporal dilation (one patient), and penile straightening (two patients). All patients were managed safely and successfully.
  
  
  CONCLUSIONS
  Primary urethral repair followed by temporary suprapubic cystostomy offers a surgical approach to complete PP implantation successfully in patients who sustain urethral injury complications, particularly for complex PP surgeries. Anele UA, Le BV, and Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation.
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA.
authors.forename: Uzoma A
authors.initials: UA
authors.lastname: Anele
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA.
authors.forename: Brian V
authors.initials: BV
authors.lastname: Le
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
keywords: Corporal Dilation; Erectile Dysfunction; Penile Fibrosis; Penile Reconstruction; SPT