A Preliminary Report on the Usage of an Intracorporal Antibiotic Cast with Synthetic High Purity CaSO4 for the Treatment of Infected Penile Implant

Abstract

Introduction Currently, the surgical treatment of infected penile prostheses is complete removal and either immediate salvage procedure, which carries a significant infection risk, or delayed implantation. With delayed implantation the risk of infection is lower, but the patient loses penile length and width due to corporal fibrosis. Aim We present our experience with the use of a novel temporary synthetic high purity calcium sulfate (SHPCaSO4) component that acts as a “spacer” at the time of removal of an infected prosthesis while providing constant delivery of local antibiotic elution to the infected area. Main Outcome Measures Demonstrate that the use of a novel material, SHPCaSO4, can be an innovative way to bridge the gap between removal of an infected penile implant and delayed reimplantation. Methods Two patients (Patient A and B) presented with pain and erythema and were found to have infected malleable penile prosthesis. Both underwent removal of all infected components, and sent for tissue culture. The SHPCaSO4 was mixed with vancomycin and tobramycin, allowed to set up for 5 minutes, and then injected into the corporal space followed by closure with 2-0 Vicryl sutures. The injected SHPCaSO4 was palpable in the penile shaft both proximally and distally, as an “intracorporal casts.” Results Patients denied pain postoperatively. Delayed implantation occurred at 6 weeks for patient A. This went uneventful and a new three-piece inflatable implant was inserted. Patient B underwent salvage placement of right malleable implant at 15 weeks, and here significant corporal fibrosis was encountered. Patients have had no infection since their delayed implantation (mean follow-up 4 months). Conclusions Data in reference to SHPCaSO4 shows that this product dissolves in approximately 4–6 weeks. This may account for the difference in the ease of delayed implantation between the two patients. Further investigation is warranted.

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

“…Also, the SEM data demonstrate the potential for eluting materials to be a nidus for infection and biofilm formation once antibiotic concentrations fall below bacterial MBCs and, therefore, emphasize the benefit of absorbable substrates. Studies have shown complete absorption of highpurity calcium sulfate within 4 to 6 weeks when combined with effective management of penile implant infection and of osteomyelitis (25,(40)(41)(42), indicating potentially wide-ranging benefits in the management of PIs.…”

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

“…One such material is calcium sulfate, with recent literature discussing its application in combination with antibiotics [16,25,26], including its safe and efficacious use in infected soft tissue sites [27].…”

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

“…17 The investigators describe filling the corpora cavernosa with a cast made of high-purity calcium sulfate that had been mixed with tobramycin and vancomycin and acts as a spacer before reimplantation of an inflatable PP several weeks later. This technique, however, is still in the experimental phase.…”