Revision Surgery for Device Malfunction with Washout Procedure

Daniar Osmonov

This video was filmed in the Department of Urology and Pediatric Urology University Hospital Schleswig Holstein in Kiel, Germany.

The case: A 49 year-old man with organic erectile dysfunction presented due to functional failure of his hydraulic penile prosthesis implanted one year before ex domo. ED was present due to diabetes. Primarily, the patient was a non-responder to PDE-5 inhibitors and to Alprostadil. The patient was sent to our center with a doubtful SST for a second opinion. During the examination we saw both cylinders which did not fill out the distal corpora properly on the both sides. The pump and both cylinders were removed. These required special care in order to remove the entire biofilm on the capsule. There was no evidence of a local infection due to the device. Therefore the reservoir was emptied and left in situ, by cutting the tubing while holding it in a stretched position. A penoscrotal implantation of penile prosthesis with ectopic high submuscular reservoir placement was performed. Our video describes all steps of the surgery. In the case of a non-infected system, for example if revision takes place due to malfunction of the system, you can use a Wilson’s mini-salvage procedure. The following components are needed to do a salvage wash-out: a syringe filled with a solution of 50% hydrogen peroxide and 50% bertadine, and a solution of vancomycine and gentamycine.

Hydrogen peroxide has a low antimicrobal efficacy and is used simply to diminish biofilm, which can be found on nearly all implanted prostheses. Bertadine has good disinfection properties. Both agents in combination achieve good efficacy in reducing biofilm. As shown in our video, Gentamycine is very effective against most gram-negative bacteria, especially against pseudomonas. Vancomycine is effective against most gram-positive bacteria, especially against resistant Staph Aureus. Thus the mixture of both drugs is an effective antimicrobial agent against free-floating bacteria.

After the wash-out, the implantation of a new device was performed. The corporal length was 12 cm to proximal and 10 cm to distal, in summary 22 cm of full length. The length of the removed device was only 20 cm. Therefore, the primary problem was not an SST, but the cylinders being too short.

We used a Coloplast Titan Touch prosthesis of 20 cm length and a 2 cm RTE on both sides.

The postoperative results after 12 weeks were satisfying.