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

Abstract

Introduction A penile prosthesis infection (PPI) is either treated with explantation of the prosthesis with a possible delayed reimplantation or a salvage procedure with an immediate reimplantation of the prosthesis. Aim We used a large, all-payer national database to investigate the use of the salvage procedure in the setting of PPI. Methods The study used years 2000–2009 of the Nationwide Inpatient Sample to identify PPIs treated with immediate salvage or explantation alone. Admissions were then stratified by various parameters to compare differences in the salvage rates. Main Outcome Measures Salvage Rate of Penile Prosthesis infection. Results A total of 1,557 patients were treated with an explantation only (82.7%) or salvage (17.3%) for PPI, a proportion that remained stable over the study period. The patients treated with salvage were younger (60.4 vs. 65.1 years), more likely to be discharged home (87.3% vs. 61.9%), and were less likely to have a severe presentation (7.2% vs. 31.6%) than those who were explanted only (P < 0.001). These factors were confirmed on multivariate regression analysis. The regression also revealed that treatment at rural hospitals had lower odds of salvage than treatment at urban teaching hospitals. Race, comorbid diabetes, and insurance status did not independently affect the salvage rate. There was no significant difference in total hospital charges between groups. Conclusions Salvage rates have remained low over the past decade. Our study elucidated several factors decreasing the chances of salvage after PPI including age, severity of presentation, and hospital setting.

Salvage penile prosthetic surgery utilizing temporary malleable implants

“…Seventeen (31%) men elected to undergo replacement of their malleable device with an inflatable prosthesis occurring on average 6.7 months after their initial washout surgery. The authors found that the patients who elected IPP replacement were typically younger by 10 years which is in line with the findings by Zargaroff et al ( 24 ). The average follow-up for Gross’ multicenter cohort was only 8.4 months so longer follow-up may find a higher proportion of men proceeding with IPP replacement.…”

“…Despite the excellent results demonstrated with Mulcahy salvage and especially with malleable rod salvage, a recent study by Zargaroff et al analyzing the national trends in treatment of IPP infections found a surprisingly low rate of salvage procedures are being performed ( 24 ). Utilizing the Nationwide Inpatient Sample database from 2000 to 2009, they reported that 82.7% of infected IPPs were treated with explantation alone while only 17.3% underwent an immediate salvage procedure.…”

A Comprehensive Review of Erectile Dysfunction in Men with Diabetes

“…A penile prosthesis infection may be either treated with explantation of the prosthesis with a possible delayed reimplantation or a salvage procedure with an immediate reimplantation of the prosthesis. In a total of 1 557 patients treated with an explantation only (82.7 %) or salvage (17.3 %) comorbid diabetes did not independently affect the salvage rate of penile prosthesis infection (Zargaroff et al, 2014).…”

The penoscrotal surgical approach for inflatable penile prosthesis placement

“…Our practice mimics others in this regard. A recent study of implant infections in the USA found only 15% were offered salvage ( 9 ).…”