Stuck In A Pickle: Urinary Retention & Penile Implant Malfunction

Written by: Dr. Jay Lee

Edited by: Dr. Joann Hsu

The case: A 79-year-old male presented to the emergency department with a 12-hour history of acute urinary retention, lower abdominal pain, and abdominal distension.


Physical exam: Physical examination revealed suprapubic fullness and distension.

The penis was noted to be partially erect, with tenderness along the shaft.

Point-of-care ultrasound demonstrated a distended bladder and identified the cause of urinary retention, as shown in the following images:

POCUS findings:

  • Patient had urinary retention on bladder ultrasound

  • This patient had a penile implant from 2022 that is demonstrated on bedside ultrasound.

  • Ultrasound demonstrated malpositioning of the device and distal erosion of the corpus cavernosum into the urethra.

What is a penile implant?

  • Inflatable penile prostheses are widely used for erectile dysfunction, a condition affecting approximately 52% of men aged 40–70 years, with device implantation being definitive treatment for refractory cases [2].

  • Although complications are uncommon, erosion and mechanical failure are well described, with case reports documenting prosthesis tubing and cylinders eroding through the cavernosum into the urethra [1].

  • Patients may present with penile pain, swelling, device malfunction, or urinary symptoms; however, some cases are initially occult.

Imaging

  • While MRI provides optimal evaluation of prostheses, it is often unavailable in the acute setting, making POCUS a critical alternative [2].

  • Ultrasound allows real-time visualization of device integrity and surrounding soft tissue, as demonstrated in Image 1, where the prosthesis is visualized within the distal urethra, and in Image 2, which shows the IPP properly positioned in the right corpus cavernosum (blue arrow), with a portion of the IPP malpositioned and eroding from the left corpus cavernosum into the urethra (red arrow).



Use of POCUS can expedite diagnosis, facilitate timely urology consultation, and improve efficiency by guiding disposition decisions. For emergency physicians, familiarity with these ultrasound findings is essential, as early recognition may prevent progression to severe complications requiring urgent surgical intervention. 


Happy scanning!



References: 

  1. Brown ET, Saunders SE, Zaslau S. Penile prosthesis pump tubing erosion into urethra appearing as inability to catheterize: a case report. J Sex Med. 2008;5(12):2960-2962. doi:10.1111/j.1743-6109.2008.00868.x

  2. Sedaghat F, Kamona A. Inflatable Penile Prosthesis Complication in the Emergency Department. Healthcare (Basel). 2024;12(10):964. Published 2024 May 8. doi:10.3390/healthcare12100964

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