Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
J Sex Med. 2012 Oct;9(10):2483-91; quiz 2492. doi: 10.1111/j.1743-6109.2012.02932.x.
When a clinically uninfected penile prosthesis has malfunctioned, removal of the broken prosthesis and simultaneous replacement with a new prosthesis is generally accepted as the treatment of choice. During prosthesis replacement, questions inevitably arise as to whether or not a washout of the implant spaces with saline or antiseptic solution should be undertaken. Since removal of the reservoir from the retropubic space is often challenging, the operating surgeon must decide whether to remove all the components or leave the reservoir in situ.
To present strategies for optimal outcomes in inflatable penile prosthesis revision surgery.
We review the current literature to find evidence regarding indications and support for washout procedures, strategies to achieve the lowest infection rates, and the need for total vs. single prosthesis component removal at the time of revision surgery. For illustration, we present the case of a clinically uninfected, malfunctioning penile prosthesis that requires replacement.
Survival from revision surgery for infection and medical complication based on published literature in peer-reviewed journals.
Recent peer-reviewed publications were summarized for guidance in addressing the dilemmas of revision surgery.
Penile prosthesis revision in a clinically uninfected patient has a higher infection rate than a first-time implantation. The combination of infection-retardant coated components, vigorous washout, proper preparation of skin incision site, use of perioperative antibiotics, and avoiding contact between the patient's skin and the implant will lower infection rates. Compared with single-component exchange, complete component removal appears to confer advantages related to future infection and malfunction. More work is needed to establish optimal strategies for handling reservoirs since clinical experience shows minimal risk of future infection in retained reservoirs.
当临床无感染的阴茎假体出现故障时，通常会选择取出破损的假体并同时更换新的假体。在更换假体时，人们不可避免地会产生疑问，即是否应使用生理盐水或抗菌溶液冲洗植入物腔。由于从耻骨后空间取出储液器通常具有挑战性，因此手术医生必须决定是否取出所有组件，还是将储液器留在原处。
提出可优化可膨胀性阴茎假体翻修手术结果的策略。
我们回顾了现有文献，以寻找有关冲洗程序适应证和支持的证据、实现最低感染率的策略，以及在翻修手术时是否需要完全或仅移除单个假体组件的证据。为了说明问题，我们介绍了一例临床无感染、出现故障的阴茎假体需要更换的病例。
根据同行评议期刊中的已发表文献，评估翻修手术后感染和医疗并发症的生存情况。
总结了最近的同行评议出版物，以帮助解决翻修手术中的困境。
与初次植入相比，临床无感染患者的阴茎假体翻修术感染率更高。采用抗感染涂层组件、彻底冲洗、正确准备皮肤切口部位、使用围手术期抗生素和避免患者皮肤与植入物接触，可降低感染率。与单组件更换相比，完全组件移除似乎在未来感染和故障方面具有优势。由于临床经验表明保留储液器的未来感染风险较低，因此需要进一步研究以确定处理储液器的最佳策略。
