Salvage Surgery for Inflatable Penile Prosthesis

In a multicenter retrospective study conducted by Gross et al., study authors analyzed the malleable implant salvage technique (MIST) The goal was to analyze outcomes after removal of an infected IPP and malleable replacement and assess the feasibility of delayed conversion back to an inflatable prosthesis.

The authors concluded that IPP infection can be safely and reliably treated with removal of infected hardware, washout, and insertion of a malleable prosthesis. This sequence was accompanied by a relatively low failure rate of 7% when compared to an 18% infection rate reported in Mulcahy’s long-term IPP salvage series and other similar cohorts in the literature. Malleable prostheses may offer the benefit of preventing corporal scarring while reducing the complexity and number of components replaced at the time of salvage surgery.

Malleable rods may offer the ideal middle ground to traditional infected IPP explant and a full washout and replacement of three-piece inflatable device. The rods maintain corporal patency after an infection and prevent scarring and penile shortening. Malleable devices also do not require a scrotal component and are ideally suited for men with scrotal pump erosions or purulence found at the time of exploration. Anecdotally, clinicians are beginning to utilize malleable rod salvage procedures for the reasons above with initial reports demonstrating good results.

Malleable salvage may also be an ideal strategy for men with isolated scrotal pump infectious complications. Revision of the scrotal pump alone will not remove infectious agents that may have colonized the tubing and other device components. Additionally, the already compromised scrotal skin may be more prone to device extrusion if a pump is reimplanted. In an effort to reduce repeat complications in this population, Köhler et al. reviewed their experience with scrotal pump erosions or infections managed with malleable substitutions.

Explantation of the penile prosthesis ensued followed by a seven-step salvage procedure and semi-rigid device substitution. The immediate salvage technique was originally described by Dr. Mulcahy with a re-infection rate of 16%. We use the “spacer” concept, implanting a semi-rigid implant to secure the space and prevent fibrosis after explant and washout. This can also be used with high satisfaction for sex, carries a nearly negligible infection rate, and can be revised to an inflatable device at a later date.

1. Lao M, Graydon RJ, Bieniek JM. Salvage penile prosthetic surgery utilizing temporary malleable implants. Transl Androl Urol. 2017;6(Suppl 5):S806–S812. doi:10.21037/tau.2017.05.12
2. Gross MS, Phillips EA, Balen A, et al. The Malleable Implant Salvage Technique: Infection Outcomes after Mulcahy Salvage Procedure and Replacement of Infected Inflatable Penile Prosthesis with Malleable Prosthesis. J Urol 2016;195:694-7. 10.1016/j.juro.2015.08.091
3. Köhler TS, Modder JK, Dupree JM, Bush NC, McVary KT
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