Temporal Caso4 Penile Cast
Advances in penile prosthesis
technology are not only limited to achieving erection, but also in the
preservation of the corpora cavernosa after a penile prosthesis infection. It
has been estimated that penile prosthesis infection rate is 1–3% and 13.3% for
revision cases respectively [Selph and Carson, 2011]. There have been many
preventative strategies to reduce the rate of infections such as intraoperative
sterile techniques, impregnated penile prosthesis and preoperative systemic
antibiotics. When infection does ensue, expedient explantation of the
prosthesis is necessary in addition to corporal irrigation with antibiotic
solution. However, such removal of the prosthesis can cause corporal fibrosis,
loss of phallic length, penile deformity in addition to psychological stress,
depression and chronic pain syndrome [Swords et al.2013].
A new approach to corporal preservation after penile prosthesis explantation
secondary to infection has been investigated by Swords and colleagues at the
University of South Florida. Their research involves the use of a temporal
intracorporeal antibiotic cast composed of synthetic high purity CaSO4 (Figure
9) that is used to provide continuous antibiotic/antifungal medication after
penile prosthesis explantation [Swords et al. 2013]. The cast provides the added
benefit of reducing corporal fibrosis and maintaining phallic length during
healing.
Figure 9: This
set of images was taken intraoperatively and displays the steps for injection
of the temporal penile cast. The compound of CaSO4 is first mixed in a sterile
basin before being filled in a syringe. Injection of the paste into the corpora
is then performed. After injection corpora and incision is closed. The
postinjection penile shaft demonstrates rigidity. Source: Swords et
al.[2013].
Currently the cast has been implanted in two
patients post penile prosthesis removal as a result of infection. The cast
self-absorbs after approximately 4–6 weeks. Results of the two test patients
revealed successful salvage replacement after the cast had resorbed. Although
one patient did have evidence of corporal fibrosis, the other patient was found
to have intact penile length and no corporal fibrosis. A more timely approach
to re-implantation of the penile prosthesis may be necessary after cast
reabsorption to prevent fibrosis in future cases. Both patients were able to be
re-implanted with a penile prosthesis and are satisfied with results without
recurrence of infection. Further patient research is warranted before such
salvage intervention can be considered a treatment option. The following
technology is not only innovative, but provides another therapy modality for
infected penile implants and a tool for surgeons to provide better outcomes to
their patients.
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