PD40-07 THE CARRION CAST: AN UPDATE ON THE USAGE OF THE INTRACORPORAL ANTIMICROBIAL DOPED SPACER FOR THE TREATMENT OF PENILE IMPLANT INFECTION (2015)

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-07 THE CARRION CAST: AN UPDATE ON THE USAGE OF THE INTRACORPORAL ANTIMICROBIAL DOPED SPACER FOR THE TREATMENT OF PENILE IMPLANT INFECTION Daniel Martinez, Eihab Alhammali, Tariq Hakky, Paul Perito, Justin Parker, and Rafael Carrion Daniel MartinezDaniel Martinez More articles by this author , Eihab AlhammaliEihab Alhammali More articles by this author , Tariq HakkyTariq Hakky More articles by this author , Paul PeritoPaul Perito More articles by this author , Justin ParkerJustin Parker More articles by this author , and Rafael CarrionRafael Carrion More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2441AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the inception of the penile prosthesis, infection has always been a significant risk. With the advent of antibiotic coated implants the rate has decreased to 1-3%, and with the “no touch technique”, 0.7%. Despite this, infection is still a reality, and a devastating complication; resulting in a decrease in penile size, increase in pain, and loss of sexual function. We present our updated series of the “Carrion Cast”, antimicrobial spacer that maintains size while treating infection, bridging the gap between explantation and reimplantation. METHODS From May 2012 to February 2014, 9 cases have been performed using high purity CaSO4 mixed with antimicrobials for the management of infected penile prosthesis in patients who are not candidates for immediate salvage. All cases had either already failed an immediate salvage and/or presented with bacteremia/septicaemia. 5 were Coloplast Genesis Semirigid Penile Prosthesis (SRPP), 2 were Coloplast Titan Inflatable Penile Prosthesis (IPP), and 2 were narrow SRPP's, sizes ranging from 17cm to 23cm. All cases underwent complete removal of prosthetic material and modified “Mulcahy Salvage” wash. The amount of CaSO4 used varied, depending on the volume of corpora (20-30cc, split between the two corpora). Serum calcium, vancomycin and tobramycin levels remained stable while the cast was palpable within the corpora. RESULTS Time to reimplantation varied (6-18 weeks), but most at 6 weeks, the time it takes for the cast to dissolve. All patients were able to have a prosthesis replaced: 1 SRPP, 3 IPP's, 2 narrow SRPP's, and 1 narrow IPP, with sizes ranging from 17cm to 20cm; 2 cases are still pending reimplantation. The mean loss of penile prosthesis length was only 1.1cm, meaning the average percent of penile length maintenance was 95%. CONCLUSIONS Penile prosthesis infection is devastating. Thanks to the “Mulcahy Salvage Protocol”, most cases can be immediately reimplanted. These cases, however, can be technically challenging, carry a higher rate of reinfection, and some patients are too sick for an immediate salvage. Thus, many infected implants undergo explantation and are left with a scarred, severely shortened penis, and inability to perform coitus. Thanks to the “Carrion Cast”, our small, yet growing series shows that they can be bridged with this antimicrobial-doped spacer, and reimplanted at 6 weeks, maintaining their penile length by 95%. Albeit a small series at this time, the “Carrion Cast” provides hope to this subset of patients that would otherwise be left in a terrible predicament. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e837 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Martinez More articles by this author Eihab Alhammali More articles by this author Tariq Hakky More articles by this author Paul Perito More articles by this author Justin Parker More articles by this author Rafael Carrion More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...