Explant of a non-functioning prosthesis and implant of a new prosthesis

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.