title: Salvage procedure for infected noneroded artificial urinary sphincters.
abstract: OBJECTIVE
  We report our experience with removal, antiseptic irrigation and immediate reimplantation of infected noneroded artificial urinary sphincters.
  
  
  METHODS
  From April 1996 to October 2000, 8 patients with an infected artificial urinary sphincter underwent a total of 9 salvage operations. All patients underwent cystoscopy before salvage to ensure nonerosion of the sphincter cuff. All previously implanted material was removed, the wounds were copiously irrigated according to a 7 solution protocol and an identical new system was implanted. All patients were discharged home the following morning on oral antibiotics.
  
  
  RESULTS
  Followup was 5 to 66 months (mean 33). The predominant organisms cultured at salvage were gram-positive cocci. Time from implantation to salvage was from 2 weeks to 64 months (mean 13.7 months). Prostatectomy was the etiology of incontinence in all except 1 case. In 5 of the 8 men a double cuff system was placed and 3 underwent concurrent 3-piece inflatable penile prosthesis salvage. The salvage procedure was done twice in 1 patient 5 months apart. The system was removed 16 months later secondary to urethral erosion. At the most recent followup the other 7 patients were free of infection with a functioning artificial urinary sphincter.
  
  
  CONCLUSIONS
  Salvage and immediate reimplantation of an infected, noneroded single or double cuff artificial urinary sphincter appears to be a valid option. Our overall success rate was 87%. The usual offending organisms are gram-positive skin flora. An associated inflatable penile prosthesis does not prohibit simultaneous salvage of the 2 devices.
authors.affiliation: Department of Urology, Indiana University Medical Center, Indianapolis, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Bryan
authors.forename: John J
authors.initials: JJ
authors.lastname: Mulcahy
authors.forename: Garrick R
authors.initials: GR
authors.lastname: Simmons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage; D020878:Device Removal; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012086:Reoperation; D007507:Therapeutic Irrigation; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary