(275) PILOT STUDY REGARDING INFLATABLE PENILE PROSTHESIS SALVAGE USING ONLY IRRISEPT® (CHLORHEXIDINE GLUCONATE 0.05%): “IRRISALVAGE”

摘要

Abstract Introduction The infected penile prosthesis salvage operation was pioneered by Dr. Mucahy et al in 1996. Since then, a multi-center study with Gross et al revealed a greater than 90% infection free rate as well a high malleable retention rate approaching 70%. As the penile prosthesis microbiome grows ever more diverse and virulent, are more antibiotics really the answer? Irrisept was recently shown to be bactericidal against an array of pathogens and improves as dwell time and layering increase. Furthermore, it was recently shown to be non-inferior to rifampin and gentamicin during index inflatable penile prosthesis (IPP) surgery. Irrisept® has not been evaluated during a salvage operation. Objective To evaluate the success of the malleable implant salvage technique using only Irrisept®. Methods We conducted an IRB-approved, retrospective chart review of two private, high volume IPP surgeons between January 2022 and May 2023. We searched cases using the CPT codes 54411 and 54417 regarding the removal and replacement of all components of a multi-component inflatable or non-inflatable penile prosthesis through an infected field at the same operative session. Only cases with an infected IPP removal and salvage washout using solely Irrisept and replacement with a semi-rigid penile prosthesis were included. Cultures and sensitives were collected during the salvage operation as well as eventual conversion back to an IPP. Results Between the two surgeons, a total of 5 salvage penile prosthesis operations were performed over the study period. All 5 met inclusion criteria and were Coloplast (CP) Titan® IPPs. 4/5 (80%) were salvage rescues with malleable devices placed due to device infection and 1/5 (20%) was due to an eroded pump. The mean patient age at salvage was 65.6. Patient information, device details, salvage, cultures, and complications can be seen on Table 1. Time from initial implant to salvage ranged from 30-70 days with a mean of 41.5 days. The mean cylinder length was 23.6 cm and the mean total device length mean was 25.4 cm. 2/5 (40%) devices were used prematurely and likely lead to their infection. Next generation sequencing was available for only one patient and was polymicrobial. All five patients had revision surgery ranging from 1.64-7.69 months with a mean of 4.34 months. Ultimately, 3/5 (60%) were replaced with an IPP and have not needed revision surgery. 1/5 (20%) patients had recurrent infection of his malleable and was replaced with a single cylinder, which also became infected and was then replaced with another single rod, which remains in place currently. 1/5 (20%) patients had their malleable device removed due to dissatisfaction and this was not replaced. Conclusions The “Irrisalvage” technique may be an option to consider in our armamentarium for salvage penile prosthesis surgery. There was only 1 postoperative infection of a malleable device and 3/5 (60%) patients were able to be reconverted back to an IPP and have had no infection recurrence. Further multi-center and randomized-controlled studies are needed prior to broad application of this technique. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Signati, Procept Robotics, Coloplast, Boston Scientific, MicrogenDx.