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Also known as
Penile prosthesis salvage surgery, IPP salvage, salvage IPP procedure, immediate salvage penile prosthesis, salvage reimplantation of penile prosthesis, penile implant salvage
Definition
A salvage penile prosthesis procedure is a surgical intervention performed when an existing penile prosthesis becomes infected or experiences mechanical failure. It involves the removal of the compromised device, a thorough washout of the implant spaces to eradicate infection, and the immediate or staged reimplantation of a new penile prosthesis. This approach aims to preserve penile length and erectile function, which might otherwise be compromised by corporal fibrosis if the infection is treated by explantation alone without immediate replacement.1,2 The procedure can utilize either an inflatable penile prosthesis (IPP) or a malleable penile prosthesis, sometimes with the malleable device serving as a temporary implant to maintain corporal space and allow for later conversion to an IPP.2
Clinical Context
Salvage penile prosthesis procedures are indicated in patients who have an existing penile implant that has developed an infection or has malfunctioned and requires replacement.1,2 Penile prosthesis infections, though less common with modern devices and surgical techniques, remain a serious complication that can lead to significant morbidity, including penile shortening and corporal fibrosis if not managed appropriately.1 Patient selection for immediate salvage typically includes those who are medically stable and do not have uncontrolled systemic infection or extensive tissue necrosis.2
The surgical procedure for salvage involves meticulous removal of all components of the infected or malfunctioning prosthesis. This is followed by an extensive washout of the corporal bodies and other implant spaces, often using a multi-solution irrigation protocol (e.g., the Mulcahy salvage protocol) to decontaminate the surgical field.1,2 A new prosthesis, either inflatable or malleable, is then implanted during the same surgical session (immediate salvage) or, in some cases, a malleable implant is placed temporarily to be replaced by an IPP at a later stage.2
Expected outcomes for salvage procedures are generally good, with high rates of infection eradication and preservation of penile form and function, allowing patients to resume sexual activity.1 Success rates for immediate salvage procedures, in terms of being infection-free, are reported to be over 80% in many series.1 The use of malleable implants as a temporary measure in salvage cases has also shown promising results, potentially serving as a bridge to a definitive IPP or even as a satisfactory long-term solution for some patients.2 Recovery involves a period of healing and adjustment to the new prosthesis, with follow-up care to monitor for any complications.