Habous Mohamad, Farag Mohammed, Williamson Ben, Laban Osama, Mahmoud Saad, Abdelwahab Osama, Elkhouly Mohamed, Kamil Usama, Binsaleh Saleh, Tal Raanan, Ralph David, Mulhall John P
Elaj Medical Centers, Urology and Andrology Department, Jedda, Saudi Arabia.
Al-azhar University, Urology Department, Cairo, Egypt.
J Sex Med. 2016 Jun;13(6):972-6. doi: 10.1016/j.jsxm.2016.04.064. Epub 2016 May 6.
Traditionally, penile implant (PI) infections have been managed by removal with immediate or delayed replacement. Recently, interest has been focused on conservative therapy (CT) using antibiotic therapy.
To investigate the success rate and predictive factors affecting the outcome of CT in PI infection patients.
Patients diagnosed with early, localized PI infection were considered candidates for CT. Exclusion criteria included temperature >37.5°C, WBC >13,000/μL, and appearance of any sign of sepsis. In patients with purulent drainage, culture swabs were taken and an antibiotic was chosen based on sensitivity results. Oral antibiotics were used until the local infection was completely resolved. Patients were evaluated weekly during this process.
Thirty-seven patients were retrospectively reviewed and constituted the study population. Mean age was 58.1 (range 37-85; SD 9.9) years. All were diabetic. Mean BMI was 31.8 (range 24-47; SD 5.0). PI was malleable in 33 cases and inflatable in 4 cases. Culture results (n = 19) included Staphylococcus epidermidis (42 %), pseudomonas (21%), Escherichia coli (21%), and S aureus (16%). Four of 37 patients needed the PI removed due to CT failure and onset of systemic symptoms, at a mean time-point of 75 ± 1.8 days after CT commencement. In men who were cured, mean time to complete healing was 49 (range 29-97; SD 15.8) days. Two of 37 patients (5%) had PI removal because of persistent penile pain despite complete wound healing, at a mean time point of 128 ± 2.5 days after CT commencement. All men managed conservatively resumed sexual intercourse.
CT of localized PI infection appears to be a viable option for such patients, with the majority of patients retaining their implant and resuming sexual activity.
传统上，阴茎植入物（PI）感染的处理方式是取出并立即或延迟更换。近来，人们的关注点集中在使用抗生素治疗的保守疗法（CT）上。
探讨PI感染患者保守疗法（CT）的成功率及影响其疗效的预测因素。
被诊断为早期局限性PI感染的患者被视为保守疗法的候选对象。排除标准包括体温>37.5°C、白细胞计数>13,000/μL以及出现任何败血症迹象。对于有脓性引流的患者，采集培养拭子并根据药敏结果选择抗生素。使用口服抗生素直至局部感染完全消退。在此过程中，每周对患者进行评估。
对37例患者进行了回顾性研究，构成了研究人群。平均年龄为58.1岁（范围37 - 85岁；标准差9.9）。所有患者均患有糖尿病。平均体重指数为31.8（范围24 - 47；标准差5.0）。33例PI为可弯曲型，4例为可膨胀型。培养结果（n = 19）包括表皮葡萄球菌（42%）、假单胞菌（21%）、大肠杆菌（21%）和金黄色葡萄球菌（16%）。37例患者中有4例因保守疗法失败及出现全身症状而需要取出PI，平均时间为开始保守疗法后的75±1.8天。治愈的患者中，完全愈合的平均时间为49天（范围29 - 97天；标准差15.8）。37例患者中有2例（5%）因伤口完全愈合后仍持续存在阴茎疼痛而取出PI，平均时间为开始保守疗法后的128±2.5天。所有接受保守治疗的男性均恢复了性生活。
局限性PI感染的保守疗法似乎对此类患者是一种可行的选择，大多数患者保留了植入物并恢复了性活动。
