Inflatable Penile Prosthesis and Salvage Protocol for Mechanical Failure: Is it Really Necessary?

Abstract

Introduction Penile prosthesis patients with mechanical failure who wish continued treatment require device removal and replacement. Infection rates as high as 18% have been reported for procedures involving replacement of malfunctioning penile prosthesis compared with 2% for primary implantation. Aim The aim of this study is to compare the outcomes of patients who have had a penile prosthesis replacement for mechanical failure to determine if those who had a mini-salvage washout procedure had better outcomes than those who did not. Methods A retrospective chart review was performed of all patients undergoing inflatable penile prosthesis replacement for mechanical failure from 1997 to 2010. Demographics, past medical history, reason for device failure, type of device, time from original implantation to failure, operative details, culture results, and follow-up data were analyzed. Main Outcome Measures Infection rates for penile implant revisions with and without mini-salvage washout. Results Forty-two patients underwent a mini-salvage procedure for mechanical failure and 87 patients underwent standard sterile replacement. There were no infections in the mini-salvage group and two (2.3%) in the standard sterile group (P = 1.00). In patients with culture data available, two patients in each group had coagulase negative staphylococcus on culture, but none of these patients developed an infection. One patient who developed an infection had an intraoperative culture, which revealed no growth. The other patient with an infection did not undergo intraoperative culture testing. Operating room (OR) time was longer with the mini-salvage procedure (156 ± 36 minutes vs. 131 ± 31 minutes, P < 0.001). Conclusions Performing a mini-salvage procedure for patients undergoing penile prosthesis replacement for mechanical failure adds to operative time but did not significantly change the infection rate and may not be indicated. Furthermore, intraoperative culture results were not predictive of postoperative infection.

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.…”

Minimising the risk of device infection in penile prosthetic surgery: a UK perspective

“…They concluded that a mini-salvage washout procedure may not be indicated for patients undergoing IPP replacement for mechanical failure. 59…”