(421) Partial versus Complete Component Exchange in Revision of the Non-Infected Inflatable Penile Prosthesis: A Multicenter Analysis.
Authors: Barham D , Hammad M , Choi E , Swerdloff D , Berk B , Chung E , Clavell-Hernandez J , Gross M , Hsieh M , Jones J , Kathrins M , Lentz A , Selph P , Simhan J , Welliver C , Yafi F 
Published: May 2023

Abstract

Introduction
Management of malfunctioning inflatable penile prostheses (IPPs) is varied, with some patients undergoing complete exchange of the entire device and others undergoing exchange of non-functioning components only. The impact of partial component exchange versus complete device exchange on infectious and non-infectious complications is unknown.

Objective
To describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction.

Methods
We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components (i.e. pump revision only, or pump and/or reservoir exchanged but cylinders left in situ). Differences between baseline demographics were assessed with two tailed student t-tests and Fisher’s exact tests. Time to revision was log transformed to reduce deviation from normality. Multivariate analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications.

Results
466 men underwent IPP revision. Of these, 377 had complete exchange of the entire device and 89 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (6.7% vs 2.1%, p=0.034). Although the partial exchange group was more likely to receive antifungals (52.8 vs 17.8%, p&lt;0.001) and have a modified salvage washout (78.4 vs 61.2%, p=0.003), this cohort was less likely to receive vancomycin and gentamicin for antimicrobial prophylaxis (60.7 vs 81.7%, p&lt;0.001). Time to revision from original implantation was significantly shorter in the partial exchange group (46 vs 168 months, p&lt;0.001). In multivariate analysis, partial exchange surgery (OR 2.6, 95%CI 0.7-9.5, p=0.15), vancomycin and gentamicin antimicrobial prophylaxis (OR 0.4, 95%CI 0.1-1.5, p=0.20), modified salvage washout (OR 1.6, 95%CI 0.3-8.4, p=0.54), and antifungal prophylaxis (OR 2.7, 95%CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of mechanical complications (20.2% vs 10.6%, p=0.019) such as pump malfunction and tubing breakage.

Conclusions
While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases the risks in men undergoing IPP revision for non-infectious indications.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Antares Pharma, Clarus Therapeutics, Cynosure, Promescent, Sprout, Viome