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Inflatable penile prosthesis and salvage protocol for mechanical failure: is it really necessary?

Jamie Bartley1, W Britt Zimmerman, Chirpriya B Dhabuwala

  • 1Department of Urology, Michigan State University College of Osteopathic Medicine-Metro Detroit Urology, Botsford Hospital, Farmington Hills, MI 48201, USA.

The Journal of Sexual Medicine
|July 5, 2012
PubMed
Summary

Penile prosthesis replacement for mechanical failure did not show improved infection rates with a mini-salvage washout procedure. This technique increased operating time without significantly reducing infection risk in patients needing device revision.

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Area of Science:

  • Urology
  • Surgical Innovation
  • Medical Device Revision

Background:

  • Penile prosthesis replacement is necessary for mechanical failures.
  • Infection risk for revision surgery is significantly higher (18%) than primary implantation (2%).

Purpose of the Study:

  • To compare outcomes of penile prosthesis replacement for mechanical failure.
  • To evaluate if a mini-salvage washout procedure improves outcomes compared to standard replacement.

Main Methods:

  • Retrospective review of inflatable penile prosthesis replacements for mechanical failure (1997-2010).
  • Analysis of demographics, failure reasons, device types, operative details, cultures, and follow-up.
  • Comparison of infection rates between mini-salvage washout and standard sterile replacement groups.

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Main Results:

  • No infections occurred in 42 mini-salvage patients; 2.3% infection rate in 87 standard replacement patients (P=1.00).
  • Coagulase-negative staphylococcus was cultured in two patients per group, with no resulting infections.
  • Mini-salvage procedures significantly increased operating room time (156 vs. 131 minutes, P<0.001).

Conclusions:

  • Mini-salvage washout for penile prosthesis replacement adds operative time without significantly altering infection rates.
  • The mini-salvage procedure may not be indicated for mechanical failures.
  • Intraoperative cultures were not predictive of postoperative infections.