Salvage of the Eroded Inflatable Penile Prosthesis: A New Concept

Furlow, William L.; Goldwasser, Benad

doi:10.1016/s0022-5347(17)43131-4

Cited by 69 publications

(37 citation statements)

References 5 publications

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“…Based on the literature's experience in the setting of prosthetic infection, explant of the Ultrex Plus and simultaneous salvage with a Dyna¯ex prosthesis was performed with satisfactory outcome in both men. 5,6 From a technical standpoint, we have experienced no mechanical failures, such as aneurysmal bulging, auto-in¯ation, system leakage, or spontaneous de¯ation. Two patients in our series have reported dissatisfaction with their prostheses despite completely normal function of the device.…”

Section: Resultsmentioning

confidence: 99%

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

1998

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The Ultrex and Ultrex Plus penile prosthesis incorporate sequential design modi®cations that afford important functional advantages that reduce the potential for mechanical failure. This retrospective study reviews our experience with these models emphasizing innovations in surgical technique and postoperative results.Implantation of Ultrex (31%) and Ultrex Plus (69%) penile prosthesis was performed in 90 impotent men with organic erectile dysfunction following comprehensive multi-disciplinary evaluation. During a follow-up interval of 7±50 months, postoperative outcome was assessed. Of this group, 10% underwent simultaneous explant of another malfunctioning in¯atable device or conversion from a semi-rigid prosthesis due to patient preference. Of the remainder, 20% selected implant surgery as their primary therapy while 73% were initially treated with various nonsurgical options prior to implantation. In all patients we employed a single peno-scrotal incision and applied the concept of controlled radial dilatation of all compartments. In our last 32 consecutive patients including eight with previous radical pelvic surgery, we utilized the preperitoneal distention balloon (PDB) facilitating safe and non-traumatic creation of the prevesical space for reservoir insertion.Post operative complications occurred in 8% of patients including pump infection and corporal deformity requiring reimplantation with AMS 700 CX cylinders, or self-contained unitarian prosthesis as a salvage procedure. Satisfactory, functional and anatomic outcome was reported in 95% of patients.Interim advances incorporated into the Ultrex and Ultrex Plus prosthesis have markedly reduced mechanical failure during our follow-up interval of up to 50 months. Importantly, controlled, non-traumatic radial dilatation of the prevesical space by the PDB may encourage broader use of the multicomponent in¯atable models, particularly in a setting of pelvic ®brosis due to previous pelvic surgery or radiation.

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Section: Resultsmentioning

confidence: 99%

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

1998

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“…Furlow and Goldwasser recommended DAGS solution that contains 500 mg neomicin, 80 mg gentamicin and 100 mg polymicin B per 1000 ml isotonic saline. 20 Carson preferred bacitracin with neomicin or gentamicin for antibiotic irrigation solution. 4 Kabalin and Kessler also used the same combination.…”

Section: Discussionmentioning

confidence: 99%

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo

et al. 2000

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The aim of this study was to determine the usefulness of intraoperative antibiotic irrigation solution and long-term effective antibiotic therapy for the infected prostheses.Forty-®ve male Wistar albino rats were divided into three equal groups and a small piece of silicone prosthesis contaminated with Staphylococcus epidermidis was implanted into the scrotum. In the ®rst group, the silicone pieces were irrigated with an antibiotic solution intraoperatively and antibiotic therapy was applied for 20 days postoperatively. The second group underwent only antibiotic therapy. In the third group (control) neither intraoperative irrigation nor postoperative antibiotic therapy was applied. Postoperative clinical infection was determined as follow-up. All implants were extracted 20 days after the implantation and cultured to observe the bacterial growth.In the ®rst group, in 13 rats the cultures were negative and in two rats, the cultures revealed positive bacterial growth. In the second group, in four rats the cultures were negative, in ®ve rats the cultures were positive and six rats revealed infectious ®ndings. In the third group, 13 rats revealed infectious ®ndings, and in the remaining two rats the cultures were positive. The differences between three groups are statistically signi®cant (P`0.05).We conclude that intraoperative antibiotic irrigation and postoperative antibiotic therapy are highly bene®cial in the infected prosthesis surgery.

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“…This is best performed using a red rubber catheter to direct irrigation fluid into all pockets in a stepwise fashion. Mulcahy and co-workers recommend a sequence of irrigating solutions including kanamycin (80 mg/l) and bacitracin (1 g/l) in normal saline followed by half-strength hydrogen peroxide, half-strength povidone/iodine solution, 5 l of pressurized normal saline containing vancomycin (1 g) and gentamicin (80 mg), half-strength povidone/ iodine, half-strength hydrogen peroxide, and finally another kanamycin/bacitracin solution 40 (Table 4). Following irrigation, gloves, instruments, and drapes are changed and a new sterile prosthesis is inserted.…”

Section: S143mentioning

confidence: 99%

“…Furlow and Goldwasser 40 advocate a 'salvage approach' to these eroded prostheses in selected cases. They treated 32 patients with single component infections or erosions by replacing the eroded component with vigorous irrigation and replacement in an area not previously operated.…”

Section: S143mentioning

confidence: 99%

Diagnosis, treatment and prevention of penile prosthesis infection

Carson

2003

Int J Impot Res

129

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The implantation of inflatable penile prostheses for the treatment of erectile dysfunction continues to be widely practiced in the United States and internationally. As third-line therapy for erectile dysfunction, the numbers of implants continue to rise as the population of men treated for erectile dysfunction increases. Complications of penile prosthesis implantation continued to decline as mechanical malfunctions have decreased as a result of re-engineering inflatable penile prostheses. Inflatable penile prostheses from both available vendors continue to be reliable, effective methods for restoring erectile function with high satisfaction rates. The most troublesome complication of these prostheses, however, is not mechanical but rather that of prosthesis infection. Prosthesis infections may result in further surgery, loss of penile tissue, and even the inability to replace penile prosthesis. While standard sterile technique perioperative antibiotics and careful surgical procedures continue to be the cornerstone of penile prosthesis infection avoidance, newer designs of penile prostheses for antibiotic coating have resulted in an improvement in the prevalence and incidents of penile prosthesis infection. For those patients in whom penile prostheses become infected despite adequate prophylaxis, newer techniques of salvage have demonstrated increasing success. Once and still the most dreaded complication of penile prosthesis implantation, prothesis infections can now be avoided by perioperative preparation and antibiotics as well as antibioticcoated penile prostheses. Treatment of penile prosthesis infections once associated with severe loss of function can often be successful with modern salvage techniques. Implanting urologists must be familiar prophylaxis, avoidance, and treatment of penile prosthesis infections.

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Salvage of the Eroded Inflatable Penile Prosthesis: A New Concept

Cited by 69 publications

References 5 publications

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo

Diagnosis, treatment and prevention of penile prosthesis infection

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