Salvage of Infected Penile Prosthesis using Novel High-Pressure Pulse Irrigation System Adapted to Urological Use in Conjunction with a new Antimicrobial Solution

Abstract

ABSTRACT Introduction Infection of a penile implant is a catastrophic event necessitating removal of the infected device. Removal of an infected implant is associated with significant morbidity, including penile fibrosis with associated shortening. Delayed reimplantation is associated with difficulty or maybe technically impossible. Mulcahy salvage protocol with modifications is the preferred approach when possible. Adequate irrigation is a challenge given the ‘deep-in-a-hole’ surgical anatomy where the implants are placed. In addition, there is no agreed-upon irrigant that is ideal for irrigation infected wounds. Objective We describe adaptation and modification of orthopedic high-pressure irrigation system for use in the salvage of penile prosthesis. In addition, we describe novel use in urology of a hypochlorous washing solution capable of removing microorganisms, disrupting biofilm, while being non-cytotoxic and skin-neutral. Methods Stryker Interpulse Pulsed Lavage System generating 15 pounds per square inch (PSI) of pressure was adapted for urological use in deep cavities using 16F red rubber Bard urethral catheter. Infected implant in a high-risk multiple comorbidities vasculopath was successfully salvaged without complications. Results Successful salvage of an infected penile prosthesis with a novel adaptation of existing high-pressure irrigation system. Demonstrated safely of use of antibiotic solution for penile irrigation. Conclusions In-vivo studies show significantly greater effectiveness of high-pressure pulsed salvage irrigation compared to bulb syringe irrigation. We present a practical, accessible, and effective modification of an existing high-pressure irrigation syringe for use in deep cavities, proximal and distal penile shaft. In addition, we report safe use of a new antimicrobial irrigant, hypochloric acid, for salvage of infected penile prosthesis. Disclosure No