Inflatable Penile Prosthesis Washout.

Although the rate of mechanical malfunction associated with inflatable penis prostheses (IPP) has been driven to less than 5%, the incidence of penile prosthesis infection ranges between 1% and 13%. Treatment for this devastating event traditionally has required systemic antibiotics with the complete removal of the device, potentially followed by reinsertion within 3–6 months. Explantation of the prosthesis in this setting may lead to the development of corporeal fibrosis, penile shortening, and ultimately, patient dissatisfaction. Penile prosthesis infection salvage protocols have been developed in an attempt to circumvent the issues associated the infected prosthesis. ... Six weeks after penile implant placement, a patient reported to this office with scrotal pain, a fixed high riding pump, scrotal induration, and impending erosion. Management options include (i) prosthesis removal with washout and IPP replacement; (ii) removal, washout with semirigid substitution; and (iii) simple removal and washout. Explantation of the penile prosthesis ensued followed by a seven-step salvage procedure and semi-rigid device substitution. The immediate salvage technique was originally described by Dr. Mulcahy with a re-infection rate of 16%. We use the “spacer” concept, implanting a semi-rigid implant to secure the space and prevent fibrosis after explant and washout. This can also be used with high satisfaction for sex, carries a nearly negligible infection rate, and can be revised to an inflatable device at a later date.