Salvage penile prosthetic surgery utilizing temporary malleable implants

Abstract

Abstract:The inflatable penile prosthesis (IPP) is an effective erectile dysfunction (ED) treatment modality when oral and injectable therapies fail to achieve satisfactory results. Unfortunately, infection of the prosthetic remains a dreaded complication occurring in a small fraction of patients despite advances in device design and surgical techniques. With a prosthetic infection or erosion, classic management has included removal of all hardware with thorough irrigation of the infected spaces. To prevent corporal fibrosis and scarring that can make a subsequent implant challenging, an immediate salvage procedure with a three-piece prosthesis has been advocated when possible. However, there has been recent interest in using malleable devices during salvage procedures to serve as a temporary implant and further improve outcomes. Based on a literature review of immediate salvage procedures for infected penile prostheses, management with typical Mulcahy washout and IPP reimplant may be quite successful in appropriately selected patients. Based on one case series and a second multicenter trial of malleable salvage procedures, utilizing a malleable as a temporary implant is similarly, if not more, successful at eradicating prosthetic infection. The malleable implant not only serves as a temporary space-filling corporal implant to prevent fibrosis, but may also prove an adequate destination therapy for some given the lower than expected rate of delayed conversion to inflatable prosthesis. Future studies are needed to better characterize the role of malleable devices for penile prosthetic salvage and query patient satisfaction with the malleable device and repeated surgeries.

Surgical Outcomes and Patient Satisfaction With the Low-Cost, Semi-Rigid Shah Penile Prosthesis: A boon to the Developing Countries

“…Hence, the SPP continues to be the major workhorse of most Andrologists in developing countries, while in developed countries its use is restricted to those who prefer a simple device or have impaired manual dexterity or for a salvage procedure (following infection or longstanding priapism). 11 …”

“…Hence, the SPP continues to be the major workhorse of most Andrologists in developing countries, while in developed countries its use is restricted to those who prefer a simple device or have impaired manual dexterity or for a salvage procedure (following infection or longstanding priapism). 11 It is generally assumed that younger patients do not need a PP. However, we had 11 patients less than 30 years of age that needed the PP to become sexually potent.…”

Infected penile prosthesis: literature review highlighting the status quo of prevention and management

“…First described in 1996, Mulcahy reported in 2000 a success rate over 80%, with further assessments reproducing similar rates [49][50][51]. A number of authors have gone onto propose their own modifications of the technique and argue in favor of modifications with different steps or entities for reimplantation, including the Hofer modification, or slightly different washout solution compositions or lavage options [4,8,[51][52][53]. However, there has been no consensus on the superiority of one algorithm to the other, and while the success rates of all have been comparable, the Mulcahy salvage procedure has maintained its popularity and advocacy and deemed an important influence for prosthetic surgeons [51,54].…”

“…However, there has been no consensus on the superiority of one algorithm to the other, and while the success rates of all have been comparable, the Mulcahy salvage procedure has maintained its popularity and advocacy and deemed an important influence for prosthetic surgeons [51,54]. Some other modified algorithms suggested washout without explantation, or even reimplantation with a temporary prosthesis or an intracorporal antibiotic high purity synthetic calcium sulfate cast that dissolves within 4 to 6 weeks to eradicate any remenants of the infection before reimplantation of another prosthesis [52,53,55].…”

The importance of the malleable implant salvage technique (MIST) in modern prosthetic urology

“…Unfortunately, not every patient is a candidate for salvage. A large percentage of men who present with infection will do so with complications involving the scrotum ( 3 ). This often precludes salvage with a 3-piece inflatable prosthesis as scrotal tissues are frequently compromised.…”