title: An outcomes analysis of over 200 revision surgeries for penile prosthesis implantation: a multicenter study.
abstract: BACKGROUND
  Inflatable penile prosthesis (IPP) implantation is a well-established treatment for medically refractory erectile dysfunction, with long-term reliability. Overall survival is 96% at 5 years and 60% at 15 years for primary (virgin) implantation.
  
  
  OBJECTIVE
  The aim of this study was to explore factors associated with success and complications of IPP revision surgery in a multicenter study.
  
  
  METHODS
  Reasons for revision including mechanical issues, patient dissatisfaction, corporal deformity, and supersonic transport (SST) deformity were recorded.
  
  
  METHODS
  At four institutions, 214 clinically uninfected IPP revisions were performed between November 2000 and November 2007. Data were incomplete for 28 cases (14%). Failure-free survival was estimated using Kaplan-Meier's Meier product limit method.
  
  
  RESULTS
  The majority of revisions were secondary to mechanical failure (N = 109; 65%) and combined erosion or infection (N = 17 + 15 = 32; 19%). Sixteen percent (N = 26) were carried out on functional uninfected prostheses secondary to patient dissatisfaction (N = 9), SST deformity (N = 10), scrotal hematoma (N = 2), or upsize revision because of corporal fibrosis (N = 5). Average age at revision was 66 years. Mean follow-up time was 55.7 months. In this study, 12 individuals required a secondary revision procedure or suffered a complication. Despite prior reports of high infection rates with revision surgery, only 5.7% of clinically uninfected and noneroded prostheses were complicated by infection or impending extrusion/erosion, following a revision washout protocol. Overall, 93% of cases were successfully revised, providing functioning IPPs.
  
  
  CONCLUSIONS
  For this study population, component exchange followed by revision washout showed a low incidence of infection and subsequent mechanical failure.
authors.affiliation: Regional Urology, Shreveport, LA 71106, USA. GDHenry@hotmail.com
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.forename: Craig F
authors.initials: CF
authors.lastname: Donatucci
authors.forename: William
authors.initials: W
authors.lastname: Conners
authors.forename: Jason M
authors.initials: JM
authors.lastname: Greenfield
authors.forename: Culley C
authors.initials: CC
authors.lastname: Carson
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
authors.forename: John
authors.initials: J
authors.lastname: Delk
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Lentz
authors.forename: Mario A
authors.initials: MA
authors.lastname: Cleves
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Jennermann
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kramer
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017060:Patient Satisfaction; D019935:Penile Implantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D015917:Penile Prosthesis / Q000009:adverse effects; D011475:Prosthesis Failure / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome