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Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Penile prosthesis (PP) is the established treatment for patients with erectile dysfunction (ED) who do not respond to phosphodiesterase inhibitors and intracavernosal injections. In general, these devices have been largely successful but there are not free of serious complication such as PP infection (PPI). PPI requires immediate surgical removal or salvage rescue of the PP.

Aim: In this report, we present two clinical cases with inflatable PP (IPP) treated locally with antibiotic and high pressure irrigation and then avoid the PP removal or salvage rescue.

Methods: We present two patients with PPI in our institution and literature review.

Main outcome measures: Resolution of the two cases.

Results: Patient A (A) was 44 years old and patient B (B) 51 years old presented PPI after three weeks (A) and eight weeks (B). Both patients were diabetic. Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum were clean and dry. They had not scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). In both cases, we performed an excision of the tissue around the pump with a high pressure pulsed irrigation (Interpulse; Stryker Corp, Kalamazoo, MI, USA). For the irrigation we used three different solutions that included povidone-iodine, antibiotics (gentamicin plus vancomicin), and hydrogen peroxyde. Finally, we performed a multilayered surgical closure with the use of aspirate drainage over 24 hours and intravenous antibiotics. The patients had a total resolution of its symptoms after 20 months (A) and 36 months (B), and the IPP worked properly.

Conclusion: This treatment could be an option for to perform specific patients with local IPP infection without systemic symptoms instead of surgical removal.

No MeSH data available.


Related in: MedlinePlus

Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum was clean and dry. He had no scrotum tenderness.
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fig1: Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum was clean and dry. He had no scrotum tenderness.

Mentions: A 44-year-old patient (A) and a 51-year-old patient (B) presented with infection of their IPP after 3 weeks (A) and 8 weeks (B). An AMS 700 IPP with InhibiZone (Boston Scientific, Voisins-le-Bretonneux, France) was implanted in patient A, and Coloplast TITAN IPP (Coloplast, Madrid, Spain) with hydrophilic coating soaked in gentamicin was implanted in patient B. Both patients were diabetic type I. Physical exploration revealed an open scrotal incision with a clear discharge (Figure 1) and approximately 25% of the pump was exposed. The rest of the incision and scrotum were clean and dry. The patients had no scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). After 2 weeks of antibiotic oral treatment the symptoms remained without changes and we proceeded to surgical treatment. The technique, alternatives, risks, and limitations were carefully discussed with the patients. We performed an excision of the tissue around the pump (Figure 2) with irrigation of the area with an Interpulse device (Figure 3). The surgical examination revealed the absence of purulent secretion. The patients had a total resolution of the symptoms and their prostheses work properly after 20 months (A) and 36 months (B).


Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery
Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum was clean and dry. He had no scrotum tenderness.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121535&req=5

fig1: Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum was clean and dry. He had no scrotum tenderness.
Mentions: A 44-year-old patient (A) and a 51-year-old patient (B) presented with infection of their IPP after 3 weeks (A) and 8 weeks (B). An AMS 700 IPP with InhibiZone (Boston Scientific, Voisins-le-Bretonneux, France) was implanted in patient A, and Coloplast TITAN IPP (Coloplast, Madrid, Spain) with hydrophilic coating soaked in gentamicin was implanted in patient B. Both patients were diabetic type I. Physical exploration revealed an open scrotal incision with a clear discharge (Figure 1) and approximately 25% of the pump was exposed. The rest of the incision and scrotum were clean and dry. The patients had no scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). After 2 weeks of antibiotic oral treatment the symptoms remained without changes and we proceeded to surgical treatment. The technique, alternatives, risks, and limitations were carefully discussed with the patients. We performed an excision of the tissue around the pump (Figure 2) with irrigation of the area with an Interpulse device (Figure 3). The surgical examination revealed the absence of purulent secretion. The patients had a total resolution of the symptoms and their prostheses work properly after 20 months (A) and 36 months (B).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Penile prosthesis (PP) is the established treatment for patients with erectile dysfunction (ED) who do not respond to phosphodiesterase inhibitors and intracavernosal injections. In general, these devices have been largely successful but there are not free of serious complication such as PP infection (PPI). PPI requires immediate surgical removal or salvage rescue of the PP.

Aim: In this report, we present two clinical cases with inflatable PP (IPP) treated locally with antibiotic and high pressure irrigation and then avoid the PP removal or salvage rescue.

Methods: We present two patients with PPI in our institution and literature review.

Main outcome measures: Resolution of the two cases.

Results: Patient A (A) was 44 years old and patient B (B) 51 years old presented PPI after three weeks (A) and eight weeks (B). Both patients were diabetic. Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum were clean and dry. They had not scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). In both cases, we performed an excision of the tissue around the pump with a high pressure pulsed irrigation (Interpulse; Stryker Corp, Kalamazoo, MI, USA). For the irrigation we used three different solutions that included povidone-iodine, antibiotics (gentamicin plus vancomicin), and hydrogen peroxyde. Finally, we performed a multilayered surgical closure with the use of aspirate drainage over 24 hours and intravenous antibiotics. The patients had a total resolution of its symptoms after 20 months (A) and 36 months (B), and the IPP worked properly.

Conclusion: This treatment could be an option for to perform specific patients with local IPP infection without systemic symptoms instead of surgical removal.

No MeSH data available.


Related in: MedlinePlus