Application of vacuum sealing drainage in penile prosthesis infection

Résumé fourni par la source

Penile prosthesis infection (PPI) represents a devastating complication that often necessitates explantation of the device. Additional surgical interventions not only take a physical and emotional toll on patients but also increase their financial burden. The conventional management of delayed reimplantation is associated with corporal fibrosis and shortening, which increases the complexity of subsequent surgery. An observational study demonstrated that delayed reimplantation resulted in a significantly greater reduction in corporal length compared to immediate salvage procedures.1 The salvage protocol offers an alternative for managing PPI by eliminating the need for a “rest period” and has been validated by reported success rates exceeding 80% for infection eradication.2 Despite its viability, this approach often encounters patient reluctance due to the prospect of multiple surgeries (second or third procedures) and the high costs associated with prosthesis replacement, which are not covered by health insurance. At our center, ~200 patients undergoing the inflatable penile prosthesis surgery were instructed to bathe with soap and remove hair prior to surgery. Vancomycin was administered 30-60 min preoperatively. Intraoperatively, the surgical site was repeatedly irrigated with a solution of vancomycin and gentamicin. Postoperatively, vancomycin was continued within 24 h, then a second-generation cephalosporin antibiotic was orally administered for two weeks. Six cases developed PPI. In three of these patients, the prosthesis had to be removed due to urethral erosion, while the other three patients developed PPI confined to the scrotum without prosthesis exposure. In an effort to avoid reoperation and prosthesis exchange, we applied vacuum sealing drainage (VSD) as an adjunct for infection control and wound healing.

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