Montgomery Brian D, Lomas Derek J, Ziegelmann Matthew J, Trost Landon W
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Int J Impot Res. 2018 Aug;30(4):147-152. doi: 10.1038/s41443-018-0026-6. Epub 2018 May 25.
Inflatable penile prosthesis (IPP) is the gold standard for medically refractory erectile dysfunction. Infectious complications remain a significant concern in IPP revision surgery. We sought to evaluate the impact of number of IPP surgeries on subsequent infection rates. A retrospective analysis was performed on all new patients (self or outside provider referred) presenting for consideration of IPP revision or salvage surgery between 2013 and 2015. Histories were reviewed including number of prior IPPs, reason for evaluation, and rate, number, and timing of prior IPP infections. No patients were operated on by the primary investigator prior to data acquisition. We identified 44 patients with at least one prior IPP presenting for consultation regarding IPP revision/salvage. There were 88 IPPs placed by 28 different surgeons. In patients with two or more devices, 55% had at least two different surgeons. The most common reason for presentation was malfunction (52%). The risk of specific device infection was strongly correlated and increased based on number of prior IPPs: 1st (6.8%; 3/44), 2nd (18.2%; 4/22), 3rd (33.3%; 4/12), 4th (50%; 4/8), and 5th (100%; 2/2) (R = 0.90, p = 0.01). Similarly, overall rates of infection positively correlated with number of prior IPP-related surgeries performed (R = 0.97, p < 0.01). The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPP-related surgeries. The majority of patients referred for penile implant surgery can expect to have experienced at least one infection by their 4th device. These data represent a change in paradigm on revision prosthetic surgery.
可膨胀阴茎假体(IPP)是药物治疗无效的勃起功能障碍的金标准。感染并发症仍是IPP翻修手术中的一个重大问题。我们试图评估IPP手术次数对后续感染率的影响。对2013年至2015年间所有因考虑进行IPP翻修或挽救手术而前来就诊的新患者(自行转诊或由外部医疗机构转诊)进行了回顾性分析。回顾了病史,包括既往IPP的数量、评估原因以及既往IPP感染的发生率、数量和时间。在数据采集之前,主要研究者未对任何患者进行手术。我们确定了44例至少有一次既往IPP且前来咨询IPP翻修/挽救手术的患者。28位不同的外科医生植入了88个IPP。在植入两个或更多装置的患者中,55%至少有两位不同的外科医生。就诊的最常见原因是装置故障(52%)。特定装置感染的风险与既往IPP的数量密切相关,且随着既往IPP数量的增加而增加:第1次(6.8%;3/44)、第2次(18.2%;4/22)、第3次(33.3%;4/12)、第4次(50%;4/8)和第5次(100%;2/2)(R = 0.90,p = 0.01)。同样,总体感染率与既往进行的IPP相关手术次数呈正相关(R = 0.97,p < 0.01)。最近一次IPP手术后发生感染的中位时间为2个月(四分位间距1 - 3.3个月)。IPP翻修/挽救手术的感染率随着每次后续IPP植入或IPP相关手术后增加。大多数因阴茎植入手术前来就诊的患者预计在植入第4个装置时至少经历过一次感染。这些数据代表了翻修假体手术模式的改变。