Saturday, April 5, 2014

New Advances in Erectile Technology (part 11)


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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