Department of Urology, University of South Florida, Tampa, FL, USA.
J Sex Med. 2013 Apr;10(4):1162-9. doi: 10.1111/jsm.12060. Epub 2013 Jan 24.
Currently, the surgical treatment of infected penile prostheses is complete removal and either immediate salvage procedure, which carries a significant infection risk, or delayed implantation. With delayed implantation the risk of infection is lower, but the patient loses penile length and width due to corporal fibrosis.
We present our experience with the use of a novel temporary synthetic high purity calcium sulfate (SHPCaSO4) component that acts as a "spacer" at the time of removal of an infected prosthesis while providing constant delivery of local antibiotic elution to the infected area.
Demonstrate that the use of a novel material, SHPCaSO4, can be an innovative way to bridge the gap between removal of an infected penile implant and delayed reimplantation.
Two patients (Patient A and B) presented with pain and erythema and were found to have infected malleable penile prosthesis. Both underwent removal of all infected components, and sent for tissue culture. The SHPCaSO4 was mixed with vancomycin and tobramycin, allowed to set up for 5 minutes, and then injected into the corporal space followed by closure with 2-0 Vicryl sutures. The injected SHPCaSO4 was palpable in the penile shaft both proximally and distally, as an "intracorporal casts."
Patients denied pain postoperatively. Delayed implantation occurred at 6 weeks for patient A. This went uneventful and a new three-piece inflatable implant was inserted. Patient B underwent salvage placement of right malleable implant at 15 weeks, and here significant corporal fibrosis was encountered. Patients have had no infection since their delayed implantation (mean follow-up 4 months).
Data in reference to SHPCaSO4 shows that this product dissolves in approximately 4-6 weeks. This may account for the difference in the ease of delayed implantation between the two patients. Further investigation is warranted.
目前，感染性阴茎假体的手术治疗是完全切除，要么立即进行挽救手术，这会带来显著的感染风险，要么延迟植入。延迟植入的感染风险较低，但患者会因 corporal 纤维化而失去阴茎长度和宽度。
我们介绍了使用新型临时合成高纯度硫酸钙（SHPCaSO4）作为感染假体切除时的“间隔物”的经验，同时为感染区域提供持续的局部抗生素洗脱。
证明使用新型材料 SHPCaSO4 可以成为桥接感染性阴茎植入物切除和延迟再植入之间间隙的创新方法。
两名患者（患者 A 和 B）出现疼痛和红斑，被发现有可弯曲阴茎假体感染。两名患者均接受了所有感染性假体的切除，并进行了组织培养。将 SHPCaSO4 与万古霉素和妥布霉素混合，放置 5 分钟，然后注入 corporal 空间，并用 2-0 Vicryl 缝线闭合。注射的 SHPCaSO4 在阴茎轴的近端和远端都可触及，形成“intracorporal casts”。
患者术后否认疼痛。患者 A 延迟植入发生在 6 周后。这一切都很顺利，插入了新的三件式可充气植入物。患者 B 在 15 周时进行了右侧可弯曲植入物的挽救性植入，但此处遇到了明显的 corporal 纤维化。自延迟植入以来，患者均未发生感染（平均随访 4 个月）。
关于 SHPCaSO4 的数据表明，该产品在大约 4-6 周内溶解。这可能是两个患者在延迟植入难度上的差异原因。需要进一步研究。
