Razdan Shirin, Siegal Alexandra R, Celtik Kenan E, Carrion Rafael, Valenzuela Robert J
Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY 10029, USA.
Department of Urology, College of Medicine at University of South Florida Tampa, FL 33606, USA.
Am J Clin Exp Urol. 2023 Apr 15;11(2):155-159. eCollection 2023.
Since the advent of the Mulcahy technique of three-piece inflatable penile prosthesis (IPP) salvage, there have been multiple iterations of salvage prosthesis procedures reported in the literature. All of these techniques employ traditional antibiotic irrigation with or without rechanneling. We present our technique of salvage IPP using 0.05% chlorhexidine gluconate (Irrisept) with corporal rechanneling for length preservation.
Our technique of IPP salvage begins with access via a 5 cm vertical midline scrotal incision. Dissection down to the corpora is performed with a combination of blunt dissection and dissection with fine tipped Metzenbaum scissors. Each component of the prior IPP is sequentially removed starting with the cylinders, followed by the pump, and finally the reservoir. Irrisept is used to copiously irrigate out both cavernosal bodies as well as the scrotal compartment and prior reservoir location. A two minute dwell time of the Irrisept is employed after mechanical irrigation. A penrose drain is placed from the space of Retzius through a separate stab incision in the scrotum. Corporotomies are closed, followed by Dartos fascia and scrotal skin. A complete change in gown and gloves of all members of the surgical team and a new set of drapes and instruments is performed. Through a separate subcoronal incision, two new corporotomies are made and separate channels created using nine inch Metzenbaum scissors. These channels are irrigated with Irrisept. A 9 mm malleable penile prosthesis (MPP) is inserted and corporotomies and skin incision are closed.
A total of four men with prior penoscrotal IPP placement underwent salvage IPP with MPP from January 2022 to October 2022. Median operative time was 165 minutes. Median preoperative cylinder size was 23.5 cm. Median postoperative malleable cylinder size was 23 cm. Median length of follow up was 4.8 months. There were no cases of MPP erosion or infection. Two patients elected to undergo repeat IPP insertion after 6 months with same cylinder size.
IPP salvage with chlorhexidine irrigation and soak as well as separate corporal channeling in a noninfected field for MPP insertion is a viable strategy for infected prostheses given the ease of performance, low risk of repeat infection of the malleable device, and maintenance of corporal length of any subsequent prostheses.
自马尔卡希三件式可膨胀阴茎假体（IPP）挽救技术问世以来，文献中报道了多种挽救性假体手术的迭代方法。所有这些技术都采用传统的抗生素冲洗，有无重新建立通道则各不相同。我们介绍一种使用0.05%葡萄糖酸氯己定（Irrisept）进行IPP挽救的技术，并进行海绵体重新建立通道以保留长度。
我们的IPP挽救技术始于通过阴囊垂直中线5厘米切口进入。钝性分离和使用精细尖头的梅茨恩鲍姆剪刀进行分离相结合，向下解剖至海绵体。先前IPP的每个组件依次移除，从圆柱体开始，接着是泵，最后是储液器。Irrisept用于大量冲洗两个海绵体以及阴囊腔和先前储液器的位置。机械冲洗后，让Irrisept停留两分钟。一根彭罗斯引流管从雷氏间隙通过阴囊上一个单独的戳孔切口引出。海绵体切开术关闭，接着是肉膜筋膜和阴囊皮肤。手术团队所有成员更换全套手术衣和手套，并更换一套新的手术巾和器械。通过一个单独的冠状下切口，进行两个新的海绵体切开术，并使用9英寸的梅茨恩鲍姆剪刀创建单独的通道。这些通道用Irrisept冲洗。插入一个9毫米的可弯性阴茎假体（MPP），然后关闭海绵体切开术和皮肤切口。
2022年1月至2022年10月，共有4名先前放置过阴茎阴囊IPP的男性接受了MPP的IPP挽救手术。中位手术时间为165分钟。术前圆柱体的中位尺寸为23.5厘米。术后可弯性圆柱体的中位尺寸为23厘米。中位随访时间为4.8个月。没有MPP侵蚀或感染的病例。两名患者选择在6个月后再次插入相同尺寸圆柱体的IPP。
对于感染的假体，使用氯己定冲洗和浸泡以及在非感染区域为插入MPP进行单独的海绵体通道建立来进行IPP挽救是一种可行的策略，因为其操作简便、可弯性装置再次感染风险低，并且能维持任何后续假体的海绵体长度。
