Implant salvage: Dilution is the solution to pollution

Penile implants, the first effective treatment of organic ED, were introduced more than 30 years ago. Simpler medical treatments have since been introduced, but implants still play an important role in treating ED when medication has been ineffective or when it is contraindicated.

Mechanical reliability of these devices has been good, and manufacturers have improved them so that repairs are less frequent. Prophylaxis against infection through the use of antibiotic-coated parts and antiseptic irrigations has also reduced the need for reoperation to attend to implant infections. When an infection does occur, a salvage procedure-during which the device is removed, a series of antiseptic irrigations cleanses the wound, and a new device is placed before the wound is closed-has had a high success rate and is gaining in popularity.

Henry et al have published a series of cases involving repair of a penile implant (see article, page 1). During these procedures, clinicians have included a mini-salvage procedure in which additional antiseptic solutions are added to the standard antibiotic washes to help eradicate or prevent infection. The lower infection rate seen in these cases was impressive.

The adage "dilution is the solution to pollution" is certainly applicable in these circumstances, and meticulous attention to compulsive antibacterial skin prep and other measures to avoid wound contamination should be employed.

Separately, two leading diabetes associations published a paper last month questioning the validity of the term "metabolic syndrome" (Diabetes Care 2005;28:2289-304). Metabolic syndrome is a symptom and blood parameter complex containing elements that increase the risk of all types of vascular disease, including myocardial infarction, stroke, and ED. ED, in these circumstances, is a gradual, insidious symptom that may predate the development of more life-threatening events.

Despite this new report, physicians should continue to advise patients to minimize each of the parameters of the metabolic syndrome (eg, lose weight, keep blood pressure under control, etc.). When a patient presents with ED, it should be a red flag that vascular disease is in progress. Further evaluation to assess the current status of the heart and other vascular beds is prudent. Prophylactic measures to correct or retard the progress of endothelial dysfunction can then be instituted.

Dr. Mulcahy, a member of the Urology Times editorial council, is professor of urology at Indiana University Medical Center,Indianapolis.