The surgery has 3 main goals: resection of the old device (with all components, including pump-cylinders and reservoir), strong wash-out with a combination of H2O2, povidone and antibiotic solutions, and finally implantation of a new 3-component inhibizone-coated device.
Clinical Case:
- Age: 49
- Gender: male
- Weight 73
- Height 1.70
- BMI 20
- Diagnosis ERECTILE DYSFUNCTION
Clinical History:
- 15 years ago the patient suffered a penile trauma with broken corpus cavernosum and secondary erectile dysfunction.
- 5 years later, due to a mechanical problem, the device was replaced by another 3-component IPP.
- After 10 years of normal functioning, the prosthesis had some mechanical problems and malfunctioned.
- Additionally, a spontaneous liquid secretion appeared in the penoscrotal junction through a small orifice, with no concomitant septic symptoms.
- The patient was regarded as having a low-grade infection in a non-functioning device. After been evaluated and discussing options, it was decided that a surgery to extract the device and replace it with an new inhibizone 3-component penile prosthesis was the best option.
Procedure Steps:
- Peno-scrotal approach with resection of the pump along with the pseudocapsule, cylinders. Complete reservoir retrieval is accomplished through a subcapsular approach in order to avoid any injury to major vessels or other structures.
- Exhaustive wash-out procedure: triple solution (povidone-H2O2-antibiotics) is completed. The procedure is repeated 2 times.
- All surgical instruments, cloths and operation clothing, and gloves are replaced.
- Implantation of a new 3 component inhibizone coated device
- Drainage and bladder catheter
Learning Points:
Low-grade infection (After 6 weeks, no sepsis signs, no purulent drainage) in a non-functioning device makes it possible to consider a rescue procedure. Strong intravenous antibiotics together with a complete resection of the prosthesis components, and exhaustive wash-out of the operating field to eliminate the biofilm component are mandatory. Implantation of a new inhibizone-coated PP in this scenario is technically feasible with good results.
