title: Dilemmas of inflatable penile prosthesis revision surgery: what practices achieve the best outcomes and the lowest infection rates? (CME).
abstract: BACKGROUND
  When a clinically uninfected penile prosthesis has malfunctioned, removal of the broken prosthesis and simultaneous replacement with a new prosthesis is generally accepted as the treatment of choice. During prosthesis replacement, questions inevitably arise as to whether or not a washout of the implant spaces with saline or antiseptic solution should be undertaken. Since removal of the reservoir from the retropubic space is often challenging, the operating surgeon must decide whether to remove all the components or leave the reservoir in situ.
  
  
  OBJECTIVE
  To present strategies for optimal outcomes in inflatable penile prosthesis revision surgery.
  
  
  METHODS
  We review the current literature to find evidence regarding indications and support for washout procedures, strategies to achieve the lowest infection rates, and the need for total vs. single prosthesis component removal at the time of revision surgery. For illustration, we present the case of a clinically uninfected, malfunctioning penile prosthesis that requires replacement.
  
  
  METHODS
  Survival from revision surgery for infection and medical complication based on published literature in peer-reviewed journals.
  
  
  RESULTS
  Recent peer-reviewed publications were summarized for guidance in addressing the dilemmas of revision surgery.
  
  
  CONCLUSIONS
  Penile prosthesis revision in a clinically uninfected patient has a higher infection rate than a first-time implantation. The combination of infection-retardant coated components, vigorous washout, proper preparation of skin incision site, use of perioperative antibiotics, and avoiding contact between the patient's skin and the implant will lower infection rates. Compared with single-component exchange, complete component removal appears to confer advantages related to future infection and malfunction. More work is needed to establish optimal strategies for handling reservoirs since clinical experience shows minimal risk of future infection in retained reservoirs.
authors.affiliation: Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hinds
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
authors.forename: Hossein
authors.initials: H
authors.lastname: Sadeghi-Nejad
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D010413:Penis / Q000601:surgery*; D011475:Prosthesis Failure / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012086:Reoperation; D016896:Treatment Outcome