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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
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.
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.
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.
