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J Urol. 2002 Dec;168(6):2464-6.

Salvage procedure for infected noneroded artificial urinary sphincters.

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  • 1Department of Urology, Indiana University Medical Center, Indianapolis, USA.

Abstract

PURPOSE:

We report our experience with removal, antiseptic irrigation and immediate reimplantation of infected noneroded artificial urinary sphincters.

MATERIALS AND METHODS:

From April 1996 to October 2000, 8 patients with an infected artificial urinary sphincter underwent a total of 9 salvage operations. All patients underwent cystoscopy before salvage to ensure nonerosion of the sphincter cuff. All previously implanted material was removed, the wounds were copiously irrigated according to a 7 solution protocol and an identical new system was implanted. All patients were discharged home the following morning on oral antibiotics.

RESULTS:

Followup was 5 to 66 months (mean 33). The predominant organisms cultured at salvage were gram-positive cocci. Time from implantation to salvage was from 2 weeks to 64 months (mean 13.7 months). Prostatectomy was the etiology of incontinence in all except 1 case. In 5 of the 8 men a double cuff system was placed and 3 underwent concurrent 3-piece inflatable penile prosthesis salvage. The salvage procedure was done twice in 1 patient 5 months apart. The system was removed 16 months later secondary to urethral erosion. At the most recent followup the other 7 patients were free of infection with a functioning artificial urinary sphincter.

CONCLUSIONS:

Salvage and immediate reimplantation of an infected, noneroded single or double cuff artificial urinary sphincter appears to be a valid option. Our overall success rate was 87%. The usual offending organisms are gram-positive skin flora. An associated inflatable penile prosthesis does not prohibit simultaneous salvage of the 2 devices.

PMID:
12441941
[PubMed - indexed for MEDLINE]
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