The Prosthesis Salvage Operation: Immediate Replacement of the Infected Penile Prosthesis

Brant, Michael D.; Ludlow, John K.; Mulcahy, John J.

doi:10.1016/s0022-5347(01)66580-7

Cited by 155 publications

(109 citation statements)

References 13 publications

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“…Revision protocols that incorporate the Mulcahy salvage technique 9 provide a practical means 20 to still provide a working penile prosthesis for infected patients who do not manifest signs of sepsis or other adverse prognostic signs. Further adoption of revision washout strategies by LVIs may prevent patients from having to undergo difficult and complex IPP procedures in the setting of corporal fibrosis, in cases where a salvage is not done and a later complex surgery is required.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

2010

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Inflatable penile prostheses (IPPs) are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume. A written questionnaire was distributed to 1968 urologists. Responses were collated and analyzed. Respondents were defined as high volume implanters (HVIs) if they placed X20 IPPs in the year preceding the survey, or low volume implanters (LVIs) if they placed p19. Our main outcome measures were surgeon volume, approach to initial IPP placement (penoscrotal vs infrapubic), strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only. HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. There are significant differences in the self-reported practice patterns of HVIs and LVIs. The importance of these differences for patient outcomes remains undefined.

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Section: Discussionmentioning

confidence: 99%

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

2010

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“…Some authors even determined the important role of intraoperative antibiotic irrigation during salvage of the clinically infected penile prostheses. 18,19 Our attempt also investigates the main role and usefulness of antibiotic irrigation in especially contaminated prosthesis.…”

Section: Discussionmentioning

confidence: 99%

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo

et al. 2000

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The aim of this study was to determine the usefulness of intraoperative antibiotic irrigation solution and long-term effective antibiotic therapy for the infected prostheses.Forty-®ve male Wistar albino rats were divided into three equal groups and a small piece of silicone prosthesis contaminated with Staphylococcus epidermidis was implanted into the scrotum. In the ®rst group, the silicone pieces were irrigated with an antibiotic solution intraoperatively and antibiotic therapy was applied for 20 days postoperatively. The second group underwent only antibiotic therapy. In the third group (control) neither intraoperative irrigation nor postoperative antibiotic therapy was applied. Postoperative clinical infection was determined as follow-up. All implants were extracted 20 days after the implantation and cultured to observe the bacterial growth.In the ®rst group, in 13 rats the cultures were negative and in two rats, the cultures revealed positive bacterial growth. In the second group, in four rats the cultures were negative, in ®ve rats the cultures were positive and six rats revealed infectious ®ndings. In the third group, 13 rats revealed infectious ®ndings, and in the remaining two rats the cultures were positive. The differences between three groups are statistically signi®cant (P`0.05).We conclude that intraoperative antibiotic irrigation and postoperative antibiotic therapy are highly bene®cial in the infected prosthesis surgery.

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“…41 In patients with severe infections and potential genitourinary gangrene, rapid prosthesis removal is imperative. 42,43 Thorough irrigation, broad-spectrum antibiotics to include coverage for anaerobic bacteria such as Bacteroides fragilis and treatment similar to that for Fournier's gangrene may result in improved postoperative results. The addition of hyperbaric oxygen treatment may salvage some tissue in these patients.…”

Section: S143mentioning

confidence: 99%

Diagnosis, treatment and prevention of penile prosthesis infection

Carson

2003

Int J Impot Res

129

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The implantation of inflatable penile prostheses for the treatment of erectile dysfunction continues to be widely practiced in the United States and internationally. As third-line therapy for erectile dysfunction, the numbers of implants continue to rise as the population of men treated for erectile dysfunction increases. Complications of penile prosthesis implantation continued to decline as mechanical malfunctions have decreased as a result of re-engineering inflatable penile prostheses. Inflatable penile prostheses from both available vendors continue to be reliable, effective methods for restoring erectile function with high satisfaction rates. The most troublesome complication of these prostheses, however, is not mechanical but rather that of prosthesis infection. Prosthesis infections may result in further surgery, loss of penile tissue, and even the inability to replace penile prosthesis. While standard sterile technique perioperative antibiotics and careful surgical procedures continue to be the cornerstone of penile prosthesis infection avoidance, newer designs of penile prostheses for antibiotic coating have resulted in an improvement in the prevalence and incidents of penile prosthesis infection. For those patients in whom penile prostheses become infected despite adequate prophylaxis, newer techniques of salvage have demonstrated increasing success. Once and still the most dreaded complication of penile prosthesis implantation, prothesis infections can now be avoided by perioperative preparation and antibiotics as well as antibioticcoated penile prostheses. Treatment of penile prosthesis infections once associated with severe loss of function can often be successful with modern salvage techniques. Implanting urologists must be familiar prophylaxis, avoidance, and treatment of penile prosthesis infections.

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The Prosthesis Salvage Operation: Immediate Replacement of the Infected Penile Prosthesis

Abstract: Our experience demonstrates the safety and advantages of the immediate salvage technique.

Cited by 155 publications

References 13 publications

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo

Diagnosis, treatment and prevention of penile prosthesis infection

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