Penile prosthesis salvage: a historical look at the Mulcahy technique and a review of the latest literature

Swanton, Amanda; Gross, Martin; Munárriz, Ricardo; Mulcahy, John J.

doi:10.1038/s41443-021-00515-7

Cited by 5 publications

(5 citation statements)

References 37 publications

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“…The advent of antibiotic impregnated devices in 2001 has led to a significant decrease in primary placement infection rates to 1–4% ( 36 - 38 ). Although there are no direct comparisons, it is reasonable to conclude that this reduction is conferred to IS patients as well ( 39 ). Gross et al in 2016 demonstrated that salvage with a malleable device could reduce the rate of reinfection from the previously published 18% down to 7% ( 12 ).…”

Section: Resultsmentioning

confidence: 99%

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Grimaud,

Barquin,

Kurnot

et al. 2024

Transl Androl Urol

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Background and Objective Since immediate salvage (IS) surgery for infected penile prosthesis (PP) was introduced nearly 30 years ago, an abundance of evidence has emerged in support of its use. IS remains underutilized by the modern urologist despite its distinct advantages. While some medical literature proposes reasons for the underuse of IS, no comprehensive review attempts to address the numerous factors limiting its implementation. Our objective is to analyze the barriers to IS surgery for infected PP with the goal of expanding utilization of this technique through a practical and standardized approach for treating urologists. Methods A narrative review of available English, peer-reviewed, medical literature relevant to the barriers to IS was completed. Searches were expanded to include literature from surgical specialties in general if hypothesized barriers were incompletely described in available PP publications. Key Content and Findings The major barriers that are likely contributing to the low rates of IS for PP surgery can be broadly classified into three major categories: institutional/systemic, medical/surgical, and patient preference. Institutional/systemically driven barriers include surgeon comfort with PP surgery, low national availability of urologists, inaccessibility of prosthetics or critical ancillary staff at the time of patient presentation and limited operating room (OR) access. Medical/surgical barriers primarily relate to reinfection fears, perceived contraindications to IS, and overall patient stability at the time of presentation. Patient preference factors inhibiting IS involve loss of trust in the medical team, psychosocial distress, dissatisfaction with the initial device prior to infection and anxiety regarding postoperative recovery. Many of the identified barriers can be overcome with increased surgical training, improved patient and surgeon understanding of PP infection, or precautionary planning. Conclusions Of the factors that contribute to low utilization of IS, many are misunderstood or unknown. Recognition of these barriers may equip urologists to provide better care to patients with prosthesis infection.

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Section: Resultsmentioning

confidence: 99%

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Grimaud,

Barquin,

Kurnot

et al. 2024

Transl Androl Urol

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“…This solution is sold under the trade name, Irrisept (Irrimax Corporation, Lawerenceville, GA, USA) and is packaged as a pre-mixed 0.05% CHG solution in a 450 mL bottle for a “jet lavage” style directed irrigation well suited for the surgical spaces of interest. At this time, there is still no consensus on which washout protocol or irrigation solutions is best in these clinical scenarios ( 47 , 51 - 53 ).…”

Section: Treatment Selection and Technique For Immediate Salvage Surgerymentioning

confidence: 99%

Narrative review of immediate salvage for penile prosthesis infection

Adams,

Tua-Caraccia,

Lentz

2024

Transl Androl Urol

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Background and Objective Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. Methods We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: “inflatable penile prosthesis”, “IPP”, “penile prosthesis”, “salvage”, “treatment”, “delayed”, “immediate”. Only English peer-reviewed publications were included. Key Content and Findings Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Conclusions Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

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“…He now recommends pressure irrigation with vancomycin/piperacillin-tazobactam/amphotericin B due to the change in identified pathogenic organisms found to cause infection. Antibiotic irrigation is then followed by dilute betadine irrigation [49]. The wound is then presumed to be sterile [50,51].…”

Section: Device Infectionmentioning

confidence: 99%

“…The wound is then presumed to be sterile [50,51]. Mulcahy and colleagues found they had an 84% success rate with salvage procedures [49,52]. The same principles are applied to a salvage procedure for an AUS.…”

Section: Device Infectionmentioning

confidence: 99%

“…Ultimately, in the setting of infection, removal of the device, intravenous broad-spectrum antibiotics and delayed reimplantation is the safest course for most patients. A salvage technique is not recommended in cases of sepsis, infection with virulent organisms, extensive cellulitis or necrosis of the tissue, diabetic patients with concomitant ketoacidosis at time of presentation, and a short incubation time from the primary implant [49]. Penile prosthesis salvage was initially motivated by the desire to prevent corporal fibrosis, scarring, and penile shortening, all results of infection on the surrounding tissues.…”

Section: Device Infectionmentioning

confidence: 99%

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Artificial Urinary Sphincter Complications: A Narrative Review

Frazier,

Jones,

Hofer

2024

JCM

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Stress urinary incontinence is a financially burdensome and socially isolating problem and can be experienced by men as a result of radical prostatectomy, radiation therapy, or other urologic surgery. Artificial urinary sphincter (AUS) placement for stress urinary incontinence is considered the ‘gold standard’ for male stress urinary incontinence. While initially only placed by specialized prosthetic surgeons, changes in urologic training have made implantation of the device by general urologists more widespread. Additionally, even though a minority of urologists place the majority of implants, many urologists may find themselves caring for patients with these devices even if they have never placed them themselves. For this reason, it is paramount that the urologic surgeon implanting the device and those caring for patients with prostheses are familiar with the various perioperative and postoperative complications of AUS implantation. This review discusses the most commonly reported complications of AUS implantation as well as those that are rarely described. Knowledge of these potential complications is necessary in order to care for patients with urologic implants.

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Penile prosthesis salvage: a historical look at the Mulcahy technique and a review of the latest literature

Cited by 5 publications

References 37 publications

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Narrative review of immediate salvage for penile prosthesis infection

Artificial Urinary Sphincter Complications: A Narrative Review

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