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Salvage procedure for infected noneroded artificial urinary sphincters
David E Bryan1, John J Mulcahy, Garrick R Simmons
1Department of Urology, Indiana University Medical Center, Indianapolis, USA.
The Journal of Urology
|November 21, 2002
Summary
Immediate reimplantation of infected artificial urinary sphincters is a successful salvage option. This procedure, involving removal, antiseptic irrigation, and new device implantation, achieved an 87% success rate in patients with noneroded devices.
Area of Science:
- Urology
- Medical Device Technology
- Infectious Disease Management
Background:
- Artificial urinary sphincters (AUS) are used to treat urinary incontinence.
- Infection is a known complication of AUS implantation.
- Salvage of infected AUS is challenging, often requiring complete removal.
Purpose of the Study:
- To evaluate the efficacy of removing, irrigating, and immediately reimplanting infected, noneroded artificial urinary sphincters.
- To assess the success rate and identify common pathogens in this salvage procedure.
Main Methods:
- A retrospective review of 8 patients undergoing 9 salvage operations for infected AUS between April 1996 and October 2000.
- Pre-salvage cystoscopy to confirm non-erosion of the AUS cuff.
- Removal of infected material, copious antiseptic irrigation, and immediate reimplantation of an identical AUS system.
- Post-operative oral antibiotics and follow-up ranging from 5 to 66 months.
Main Results:
- The predominant organisms cultured were gram-positive cocci.
- The mean time from initial implantation to salvage was 13.7 months.
- Seven out of eight patients (87.5%) had a functioning, infection-free AUS at a mean follow-up of 33 months.
- One patient required device removal 16 months later due to urethral erosion.
- Prostatectomy was the cause of incontinence in most cases.
Conclusions:
- Salvage and immediate reimplantation of infected, noneroded artificial urinary sphincters is a viable and successful option.
- Gram-positive skin flora are the most common causative organisms.
- Simultaneous salvage of an artificial urinary sphincter and an inflatable penile prosthesis is feasible.