Immediate salvage with inflatable penile prosthesis in an infected field: A contemporary multi-institutional cohort

Abstract

ABSTRACT Introduction Contemporary management of inflatable penile prosthesis (IPP) infections involves removal and replacement to minimize corporal fibrosis and penile shortening. Many urologists prefer a malleable prosthesis (MP) followed by staged conversion to IPP, a technique thought to improve outcomes by allowing treatment of the infection while maintaining intracorporeal volume. A staged procedure involves additional surgery with associated risks. Previous studies suggest an 18% infection risk of placing a second device in a non-infected, revision setting, and that infection risk increases with each subsequent procedure. Objective Our study aims to delineate whether immediate IPP salvage in an infected field yields similar complication rates to the staged approach. Methods Retrospective review at 5 institutions from February 2010 to October 2020 identified patients with IPP infection who underwent IPP salvage. Demographic, laboratory, operative, and microbiology data were collected. Emphasis was placed on the salvage operative technique, duration of antibiotics, and post-salvage complications. Results 19 patients underwent immediate salvage with IPP in the setting of a suspected infection. Average age at initial implantation was 59.9 years. Median time from initial implant to presentation with infectious symptoms was 2.4 months, and revision was performed a median of 1.5 days after presentation and initiation of antibiotics. Intraoperative complications were rare (5.3%), and post-salvage complications were 21.1%, including 1 cylinder herniation and 3 post salvage infections (15.8%). Only 1 post-salvage infection showed concordance with initial cultures while 1 was discordant and the third showed no growth (Table 1). Fisher's exact test showed diabetes, purulence in the operative field, use of drain, or washout type were not associated with infection post-salvage. Conclusions Immediate IPP salvage in the setting of an acutely infected field shows a complication profile not exceeding published data in the staged revision setting. Although staged MP-IPP salvage has been favored by many surgeons, the complication profile may be equivalent to immediate IPP salvage, and the risks of a subsequent operation should be considered. Disclosure Work supported by industry: no.