Duke University School of Medicine, Durham, NC, USA.
Division of Urology, Duke University Medical Center, Durham, NC, USA.
J Sex Med. 2018 Dec;15(12):1673-1677. doi: 10.1016/j.jsxm.2018.10.002. Epub 2018 Nov 13.
Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis.
To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged.
We considered a "severe diabetic" as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics.
Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage.
All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15-39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP.
Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage.
STRENGTH & LIMITATIONS: To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature.
Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage. Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673-1677.
从历史上看，感染阴茎假体的立即挽救的禁忌症包括器械上有脓液，糖尿病患者有脓性感染和严重糖尿病。这些临床原则是在 20 世纪 90 年代至 21 世纪初提出的，依据的是有限的回顾性系列研究或专家意见。自这些禁忌症发布以来，器械设计，手术技术， corporal 冲洗方案以及围手术期抗生素预防措施均得到了改善，这使我们能够重新评估是否可以扩大感染性阴茎假体立即挽救的标准。
报告严重糖尿病患者是否可以安全地立即挽救有脓性的可充气阴茎假体（IPP）。
我们将“严重糖尿病”定义为疾病已发展到饮食控制和口服药物治疗无法控制的程度，因此患有胰岛素依赖型 2 型糖尿病（IDDM II）的患者。我们回顾性分析了 2011 年 7 月至 2017 年 11 月期间，6 例连续患有 IDDM II 和有脓性 IPP 的患者，他们立即进行了挽救性手术。除了立即更换外，每位患者均接受了经导管定向抗微生物腔内冲洗和器械培养。所有患者均于次日出院，口服抗生素。
结果包括立即挽救后的重复阴茎假体感染或任何其他并发症。
所有 6 例患者均愈合良好，在术后 6-8 周的随访中无感染。挽救后 15-39 个月，无患者再次感染或发生任何其他并发症。5 例患者接受了可弯曲替换装置，1 例患者在挽救手术后 7 个月被选择性转换为 IPP。1 例患者在挽救过程中根据患者的喜好接受了 IPP。目前所有患者对可弯曲阴茎假体或 IPP 均满意。
立即挽救可减轻感染性阴茎假体相关的发病率，例如不可逆的阴茎缩短和 corporal 纤维化。我们的发现表明，比最初想象的更多的患者可能是立即挽救的候选者。
据我们所知，这是第一项评估在患有晚期糖尿病的患者中，立即挽救有脓性 IPP 的患者的结果的研究。研究的局限性包括样本量小和回顾性。
我们的结果表明，患有 IDDM II 的患者如果有脓性阴茎假体，可能是安全有效的立即挽救的候选者。
