An Outcomes Analysis of over 200 Revision Surgeries for Penile Prosthesis Implantation: A Multicenter Study

Abstract

Introduction Inflatable penile prosthesis (IPP) implantation is a well-established treatment for medically refractory erectile dysfunction, with long-term reliability. Overall survival is 96% at 5 years and 60% at 15 years for primary (virgin) implantation. Aim The aim of this study was to explore factors associated with success and complications of IPP revision surgery in a multicenter study. Main Outcome Measures Reasons for revision including mechanical issues, patient dissatisfaction, corporal deformity, and supersonic transport (SST) deformity were recorded. Methods At four institutions, 214 clinically uninfected IPP revisions were performed between November 2000 and November 2007. Data were incomplete for 28 cases (14%). Failure-free survival was estimated using Kaplan–Meier’s Meier product limit method. Results The majority of revisions were secondary to mechanical failure (N = 109; 65%) and combined erosion or infection (N = 17 + 15 = 32; 19%). Sixteen percent (N = 26) were carried out on functional uninfected prostheses secondary to patient dissatisfaction (N = 9), SST deformity (N = 10), scrotal hematoma (N = 2), or upsize revision because of corporal fibrosis (N = 5). Average age at revision was 66 years. Mean follow-up time was 55.7 months. In this study, 12 individuals required a secondary revision procedure or suffered a complication. Despite prior reports of high infection rates with revision surgery, only 5.7% of clinically uninfected and noneroded prostheses were complicated by infection or impending extrusion/erosion, following a revision washout protocol. Overall, 93% of cases were successfully revised, providing functioning IPPs. Conclusion For this study population, component exchange followed by revision washout showed a low incidence of infection and subsequent mechanical failure.

Long-Term Infection Outcomes of 3-Piece Antibiotic Impregnated Penile Prostheses Used in Replacement Implant Surgery

“…Decreasing colonization and biofilm may decrease mechanical malfunction but the underlying mechanism for increased malfunction in colonized devices is unknown. 19 To our knowledge the statistically significant difference in secondary revision due to fluid loss is also unexplained.…”

National Trends in the Treatment of Penile Prosthesis Infections by Explantation Alone vs. Immediate Salvage and Reimplantation

“…Although the immediate salvage procedure has not been definitively compared with the delayed approach, its major hypothesized advantage is a lower risk of penile shortening on subsequent reimplantation of a new penile prosthesis with a potential to increase patient satisfaction [7,15,16]. Furthermore, recent studies have studied salvage, or revision, procedures in the context of mechanical prosthesis failure [6,[17][18][19]. Thus, it is relevant to study the Figure 1 displays the change in the national frequency of explantation vs. salvage over 10 years.…”

History, Contemporary Outcomes, and Future of Penile Prostheses: A Review of the Literature

“…Five‐year infection free survival rates for those undergoing washout were 96% vs. 64% of those without . Additionally, patients undergoing subtotal device removal experienced increased rates of infection (9.1%) compared with those with complete device removal (5%); however, the need for complete device removal remains controversial . Improvements noted with the washout procedure are independent of the utilization of antibacterial prosthetic devices when compared with traditionally reported infection rates .…”