Adams Eric S, Tua-Caraccia Rafael D, Lentz Aaron C
Department of Urology, Duke University Medical Center, Durham, NC, USA.
Transl Androl Urol. 2024 Apr 30;13(4):584-595. doi: 10.21037/tau-23-277. Epub 2024 Apr 18.
Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique.
We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included.
Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length.
Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.
对于采用侵入性较小的治疗方法无效的勃起功能障碍（ED）男性患者，植入阴茎假体是一种可靠的选择。虽然阴茎假体感染的发生率有所下降，但仍然是一种严重的并发症。在此，我们讨论为什么即刻挽救手术是治疗植入物感染的一项重要技术。我们还将描述该技术的相关进展。
我们通过基于计算机的检索在PubMed上对所有关于阴茎假体感染管理的相关文章进行了叙述性综述，包括指南、病例系列、综述和专家意见。使用的检索词包括：“可膨胀阴茎假体”“IPP”“阴茎假体”“挽救”“治疗”“延迟”“即刻”。仅纳入英文同行评审出版物。
历史上，出现阴茎假体感染的患者仅通过完全移除假体而不进行更换来处理。虽然这种策略是安全的，但它会加速即刻勃起功能障碍和阴茎海绵体纤维化，导致阴茎长度缩短以及后续假体更换难度增加。既往病例系列报道了非手术治疗局部阴茎假体感染的成功案例，但保守治疗的作用仍然有限。目前即刻挽救的标准做法是移除感染的假体并进行冲洗，然后立即更换新的阴茎假体。该技术已被证明是安全有效的，从而使患者能够恢复性交并保持阴茎长度。
即刻挽救手术安全有效，已成为大多数阴茎假体感染患者治疗的首选策略。
