A preliminary report on the usage of an intracorporal antibiotic cast with synthetic high purity CaSO4 for the treatment of infected penile implant.
BACKGROUND
Currently, the surgical treatment of infected penile prostheses is complete removal and either immediate salvage procedure, which carries a significant infection risk, or delayed implantation. With delayed implantation the risk of infection is lower, but the patient loses penile length and width due to corporal fibrosis.


OBJECTIVE
We present our experience with the use of a novel temporary synthetic high purity calcium sulfate (SHPCaSO4) component that acts as a "spacer" at the time of removal of an infected prosthesis while providing constant delivery of local antibiotic elution to the infected area.


METHODS
Demonstrate that the use of a novel material, SHPCaSO4, can be an innovative way to bridge the gap between removal of an infected penile implant and delayed reimplantation.


METHODS
Two patients (Patient A and B) presented with pain and erythema and were found to have infected malleable penile prosthesis. Both underwent removal of all infected components, and sent for tissue culture. The SHPCaSO4 was mixed with vancomycin and tobramycin, allowed to set up for 5 minutes, and then injected into the corporal space followed by closure with 2-0 Vicryl sutures. The injected SHPCaSO4 was palpable in the penile shaft both proximally and distally, as an "intracorporal casts."


RESULTS
Patients denied pain postoperatively. Delayed implantation occurred at 6 weeks for patient A. This went uneventful and a new three-piece inflatable implant was inserted. Patient B underwent salvage placement of right malleable implant at 15 weeks, and here significant corporal fibrosis was encountered. Patients have had no infection since their delayed implantation (mean follow-up 4 months).


CONCLUSIONS
Data in reference to SHPCaSO4 shows that this product dissolves in approximately 4-6 weeks. This may account for the difference in the ease of delayed implantation between the two patients. Further investigation is warranted.
Department of Urology, University of South Florida, Tampa, FL, USA.
Kelly
K
Swords
Daniel R
DR
Martinez
Jorge L
JL
Lockhart
Rafael
R
Carrion
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002133:Calcium Sulfate; D020099:Coated Materials, Biocompatible; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012086:Reoperation; D014031:Tobramycin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D014640:Vancomycin; D014031:Tobramycin; D002133:Calcium Sulfate