title: Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study.
abstract: OBJECTIVE
  Reoperation of penile implants carries a higher risk of infection (7% to 18%). Positive cultures and visible bacterial biofilm have been shown to be present on clinically uninfected inflatable penile prostheses (IPPs) at revision. A salvage irrigation protocol has proved to rescue patients with a clinically infected IPP. During revision surgery for noninfectious reasons we investigated washing out the implant space at revision surgery and using an antibiotic coated replacement prosthesis to determine if it would decrease subsequent infection rates.
  
  
  METHODS
  At 3 institutions 183 patients with a penile prosthesis underwent revision surgery for noninfectious reasons between June 2001 and October 2003. Of these patients 140 had the entire implant removed and then underwent antiseptic solution lavage of the implant spaces (revision washout), followed by replacement with a 3 piece IPP. This revision washout is a modification of the original Mulcahy salvage procedure. In the remaining 43 patients the implant was removed but they did not undergo antiseptic irrigation before replacement with an antibiotic coated IPP. Patients were followed for 6 to 33 months, while observing for failure.
  
  
  RESULTS
  Four of the 140 patients (2.86%) who underwent removal of the entire implant with irrigation of the implant spaces with antiseptic solutions and replacement with an IPP have had infection. In the remaining group 5 of the 43 patients (11.6%) who did not undergo antiseptic irrigation had infection. The difference was statistically significant at the 5% level (Fisher's exact test p = 0.034).
  
  
  CONCLUSIONS
  Early results of combining complete implant removal and modified salvage protocol indicate a markedly decreased incidence of infection in patients with a penile prosthesis undergoing revision for noninfectious reasons.
authors.affiliation: From Regional Urology, 255 Bert-Kouns Street, Shreveport, Louisiana 71196, USA. GDHenry@hotmail.com
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
authors.forename: John R
authors.initials: JR
authors.lastname: Delk
authors.forename: Culley C
authors.initials: CC
authors.lastname: Carson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wiygul
authors.forename: Chris
authors.initials: C
authors.lastname: Tornehl
authors.forename: Mario A
authors.initials: MA
authors.lastname: Cleves
authors.forename: Ari
authors.initials: A
authors.lastname: Silverstein
authors.forename: Craig F
authors.initials: CF
authors.lastname: Donatucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012086:Reoperation