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Immediate salvage with inflatable penile prosthesis in an infected field is associated with a high success rate

International Journal of Impotence Research volume 35, pages 490–491 (2023)Cite this article

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One of the most frustrating complications following insertion of an inflatable penile prosthesis (IPP) for both patients and surgeons is infection. Infected prostheses were historically managed with removal and delayed replacement; however, this was associated with corporal fibrosis and penile shortening. In an effort to minimize these, in 1996 Dr. Mulcahy described his groundbreaking salvage technique involving removal and immediate replacement with a new prosthesis in the same operative setting [1]. Many urologists now prefer to place a malleable prosthesis (MPP) at time of removal and washout, which can then be followed by staged conversion to an IPP [2]. Salvage with a MPP is thought to preserve the corporal space while minimizing the risk of infection by reducing the surface area of implanted hardware, decreasing scrotal manipulation, and providing another opportunity to disinfect the field [2]. Limitations to this approach include the risks of having multiple surgeries, including the known increase in infection risk with each subsequent operation [3]. The aim of this study was to investigate in a contemporary cohort whether immediate salvage of an infected IPP with a new IPP in the same operative setting would yield results comparable to the staged salvage approach.

An IRB approved retrospective review of all IPP infections that underwent immediate salvage with an IPP was performed at five different institutions between February 2010 and October 2020. All patients underwent explant of the infected IPP, full or modified Mulcahy washout, and immediate replacement with an IPP. A full Mulcahy washout consisted of pressure irrigation, antibiotic irrigation, closing of the skin, changing of gowns and gloves by the operating team, and re-prepping the surgical field prior to replacement of the IPP. A modified Mulcahy washout included irrigation with antibiotic solutions and changing of gloves only. Demographic, clinical, laboratory, operative, and microbiology data were collected. Post-salvage complications were identified over the duration of available follow-up. Fisher’s exact tests were used to determine associations between operative variables and infectious complications after IPP salvage.

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Additional data are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA

    Daniel Jiang, John Barnard, David W. Barham & Faysal A. Yafi

  2. Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA

    James Furr

  3. Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Raleigh, NC, USA

    Aaron Lentz

  4. Department of Urology, Jessa Hospital Hasselt, Hasselt, Belgium

    Koenraad van Renterghem

  5. Department of Urology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    Patrick Selph

Authors
  1. Daniel Jiang
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  2. John Barnard
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  3. David W. Barham
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  4. James Furr
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  5. Aaron Lentz
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  6. Koenraad van Renterghem
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  7. Patrick Selph
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  8. Faysal A. Yafi
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Contributions

JF, AL, KR, PS, and FAY designed experiments, collected data, and approved the final manuscript; DJ designed experiments, collected data, analyzed data, and wrote the manuscript; JB designed experiments, analyzed data, and contributed to writing and editing the manuscript; DWB helped to organize data and contributed to writing and editing the manuscript.

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Correspondence to Daniel Jiang.

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Jiang, D., Barnard, J., Barham, D.W. et al. Immediate salvage with inflatable penile prosthesis in an infected field is associated with a high success rate. Int J Impot Res 35, 490–491 (2023). https://doi.org/10.1038/s41443-022-00576-2

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  • DOI: https://doi.org/10.1038/s41443-022-00576-2

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