Chloe E Peters1, Evan C Carlos2, Aaron C Lentz3. 1. Duke University School of Medicine, Durham, NC, USA. 2. Division of Urology, Duke University Medical Center, Durham, NC, USA. Electronic address: evan.carlos@duke.edu. 3. Division of Urology, Duke University Medical Center, Durham, NC, USA.
Abstract
INTRODUCTION: Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis. AIM: To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged. METHODS: We considered a "severe diabetic" as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics. MAIN OUTCOME MEASURE: Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage. RESULTS: All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15-39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP. CLINICAL IMPLICATIONS: Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage. STRENGTH & LIMITATIONS: To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature. CONCLUSION: Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage. Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673-1677.
INTRODUCTION: Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabeticpatients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis. AIM: To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged. METHODS: We considered a "severe diabetic" as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics. MAIN OUTCOME MEASURE: Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage. RESULTS: All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15-39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP. CLINICAL IMPLICATIONS: Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage. STRENGTH & LIMITATIONS: To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature. CONCLUSION: Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage. Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673-1677.