(549) Case Report of an IPP Reservoir Salvage Following Infection

Abstract

Abstract Introduction Inflatable penile prosthesis (IPP) infections are rare and devastating. IPP infections are treated with either explant or salvage, the latter with either a malleable or inflatable device. Isolated component infections are very rare in the literature. This is the first description of successful treatment of an isolated IPP reservoir infection, with preservation and eventual reuse of the patient’s uninfected pump and cylinders. Objective To report a case of successful IPP salvage after an isolated reservoir infection. Methods This is a case study of IPP reservoir explant and eventual reimplant in a 51-year-old male, with preservation of the implant pump and cylinders. Past medical history is notable for HIV, hypertension, and hyperlipidemia. The patient had a Coloplast Titan IPP placed penoscrotally in November 2020 for treatment of post-prostatectomy erectile dysfunction. The reservoir was placed ectopically in the patient’s right high submuscular space. Results In January 2021 the patient underwent emergent exploratory laparoscopic washout and drain placement at a different hospital for perforated appendicitis. The IPP reservoir was not encountered during this procedure. In March 2021 he presented to that same hospital with recurrent fevers and right lower quadrant pain. CT showed increased peritoneal stranding and thickening surrounding the IPP reservoir as well as multiple small, complex loculated fluid collections suspicious for abscesses external to the reservoir. There was no evidence of infection of the pump or cylinders on imaging or physical exam. He was transferred to Dartmouth-Hitchcock Medical Center for further care. Conservative treatment with intravenous vancomycin, Zosyn, and fluconazole yielded no change after 48 hours. Three days after initial presentation, the reservoir was explanted during a collaborative procedure with general surgery, during which the appendix remnant was also removed. Intraoperatively the penile prosthesis reservoir was encased in a dense rind that was incised and drained. Copious purulent material was sent for culture, which showed multi-organism aerobic and anerobic bacteria. The reservoir was removed and the remnant tubing to the pump was clamped. The abdomen was irrigated repeatedly with saline, dilute betadine, vancomycin, gentamicin, Zosyn, and amphotericin. The prothesis tubing was cut as low as possible, capped, and wrapped with a paste of vancomycin mixed with Zosyn and amphotericin. There were no intraoperative complications. The patient was discharged two days later. At his one-week postoperative visit, he was readmitted for interventional radiology drain placement due to abdominal abscess recurrence. Once the recurrent abscess had resolved, he underwent successful radiation treatment for recurrent prostate cancer. In March 2022, the reservoir was successfully replaced into the left high submuscular space via counter incision and the dormant cylinders and pump were reconnected. The patient continues to do well, with no signs of recurrent infection and with excellent device function. He is satisfied with the result of surgery. Conclusions To our knowledge this is the only case of isolated IPP reservoir infection successfully treated with reservoir explant and eventual replacement. The original IPP pump and cylinders were preserved without issue and eventually reused. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.