—Dr. Trost Commentary and Key Take-home Points—
Although relatively uncommon, penile implant infections represent a challenging and potentially devastating complication of penile prosthesis surgery. Revision surgery after prior infections can increase the level of difficulty and risk of intra- and post-operative complications. In the current study, the authors proposed a possible mechanism to reduce the amount of scar tissue encountered at the time of penile prosthesis implantation by using Mitomycin C. In general, the manuscript provides a creative suggestion to improve outcomes, however, as it currently stands, the manuscript itself is not able to come to any definitive conclusions. Since the paper only includes 5 individuals and does not have a comparator group (men who did not receive Mitomycin C), few conclusions can be drawn about the efficacy compared to any other treatment or no therapy. Similarly, there are no objective measures used in the study to determine whether the treatment was successful or not. And in my experience with salvage surgery after prior infection, placement of the cylinders is generally not too challenging. Typically, the challenging areas are where the original infection occurred, which is most often around the area of the pump. Because of these factors, the take home message, in my opinion, is that Mitomycin may represent an intriguing option to reduce scarring prior to repeat surgery but that further studies are required to determine if this treatment has any benefit over the current standard of care alone (device explantation vs washout surgery).
As with all surgical treatments, infection is a possible complication during penile prosthesis implantation. When infection occurs, the traditional method is to fully extract the implant and then eventually attempt reimplantation after a period of healing. Reimplantation is riskier than before due to the buildup of scar tissue, increasing the possibility of perforation, urethral injury, recurrent infection, smaller penis size, or a complete inability to perform corporal dilatation.
To address this challenging clinical scenario, the authors from the current study instilled Mitomycin C (an antitumoral antibiotic) to serve as an antifibrotic agent. Their hypothesis was that Mitomycin C could lessen scarring after explantation allowing for safer reimplantation and preservation of penile size.
The study included 5 patients with infected penile implants whose symptoms required urgent device explantation with anticipated future reimplantation. All were tested for sensitivity to mitomycin C prior to explantation surgery where the implant was fully removed, pressure washed and re-sterilized. The mitomycin C was then instilled and washed out before the incision was closed.
Results demonstrated that all 5 men were able to undergo a successful reimplantation between 10-12 weeks after explantation. Fibrous tissue was found in all 5 cases at the time of reimplantation but was easily excised. Patients were discharged same-day and patients were followed for 3-9 months after reimplantation without complication.
The authors suggested that the use of Mitomycin C in the current study led to less severe scarring and permitted successful salvage surgery in all 5 men 10-12 weeks after their initial explantation.
Reference for Article
Shaeer, Osama et al.Sexual Medicine, Volume 7, Issue 3, 357 – 360