BOVINE
PERICARDIUM IN PENILE PROSTHESIS REIMPLANTATION
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EDUARDO J. LOPES, TARSILA C. SANTOS, MODESTO JACOBINO
Section of Urology, University Hospital, Federal University of Bahia, Salvador, Bahia, Brazil
ABSTRACT
We present a case of a patient who underwent a late penile prosthesis implant using bovine pericardium as a complement to the tunica albuginea involved in intense fibrosis that destroyed the corpus cavernosum after an infectious manifestation. The advantages of using bovine pericardium in the substitution of the tunica albuginea are discussed and its first use as a penile prosthesis lining is reported.
Key words:
penile prosthesis; infection; graft; pericardium; cattle
Int Braz J Urol. 2007; 33: 74-6
INTRODUCTION
The
incidence of infection in penile prosthesis implant surgery is approximately
3% (1,2). With this low percentage, the late implant is the most adopted
option, and, eventually, the intense fibrosis that involves the corpora
cavernosa makes the re-implantation of a new prosthesis more difficult
(1,2).
The authors report a case of a diabetic
patient who presented extrusion of the prosthesis through the gland. Conservative
treatment was initially adopted, followed by a late implant that required
a reconstruction of the tunica albuginea with biological material.
CASE REPORT
A
62-year-old diabetic patient with a penile prosthesis implant presenting
a perforation of the gland and partial extrusion of the prosthesis that
had been implanted 3 years before was attended in emergency. As the right
unit of the prosthesis perforated the gland and was partially extruded,
its removal was achieved through the extrusion location. The left unit
was removed through the same orifice after verification that both units
were occupying the same space due to a complete destruction of the intercavernous
septum. The material was collected for culture and antibiotic therapy
with cephalosporin and aminoglycoside was begun. Following this, the space
was cleansed with 0.9 % physiological saline containing gentamicin. A
suture of the corpus cavernosum was performed using vycril 2-0 and the
orifice of the glandar corpus spongiosum was sutured with chrome-catgut
3-0 in 2 simple stitches. The result of the culture revealed the presence
of Staphylococcus aureus and Streptococus epidermidis sensitive to the
adopted antibiotic therapy.
Sixty days after the resolution of the infectious
condition, a new AMS 650 prosthesis was re-implanted through penoscrotal
access. The prophylactic antibiotics used were cefazolin (1g/IM/day for
72 h), gentamicin sulfate (80 mg/IM, 8 every 8 hours for 48 h), metronidazol
(400 mg IV of 8 every 8 h for 48 h), and gentamicin sulfate (160 mg in
physiological saline solution) where the prosthesis was submersed. Due
to the intense fibrosis and the small space within the tunica albuginea,
it was only possible to implant a single unit. We opted for the inverted
insertion of the prosthesis in the distal extremity of the tunica albuginea
using the small space inside the corpus cavernosum (Figures-1 and 2).
The 4 mm bovine pericardium was used to line the entire extension of the
implanted prosthesis, complementing the fibrosed tunica albuginea (Figure-3).
Two years later, the patient is satisfied with the result and has been
maintaining regular sexual relations without any complaints or recurrences.
COMMENTS
When
infection occurs in a penile prosthesis implant, 2 procedures can be adopted:
1) a rescue procedure, which requires an exhaustive cleansing of the area,
antibiotic therapy and the re-implantation of a new prosthesis at the
same time (this is considered an exception despite the good result obtained
by some authors (2); and 2) late implant, necessitating removal of the
prosthesis, local cleansing, specific treatment for the infection and
implant of a new prosthesis following remission of the infection (2).
We chose the second option because of our
greater experience with it and because this procedure is more discussed
and accepted. The period between the removal of the prosthesis and the
re-implant remains uncertain, varying from 2 to 39 months (with a mean
of 8 months) (1,2). In this case, we opted for the implant of a new prosthesis
2 months after the first intervention.
Even though synthetic materials are available
and inactive, they have the disadvantage of presenting a larger rate of
infection, inelasticity and fibrosis of the corpora cavernosa (1,2). On
the other hand, the tensional strength of the biological material has
been questioned, this material is not readily available and has a larger
risk of diseases transmission (1).
We have chosen bovine pericardium because
of its lower cost, inertia, elasticity, absence of transmission of diseases,
low probability of retraction and good resistance to tension that allow
it to cover large defects without forming protuberances (3). Despite having
never been used as a lining for a penile prosthesis, we believe that it
is another option in extreme situations such as the one we are describing.
CONFLICT OF INTEREST
None declared.
REFERENCES
- Palese MA, Burnett AL: Corporoplasty using pericardium allograft (tutoplasty) with complex penile prosthesis surgery. Urology. 2001; 58: 1049-52.
- Mulcahy JJ, Brant MD, Ludlow JK: Management of infected penile implants. Tech Urol. 1995; 1: 115-9.
- Pomerantzeff PM, Zerbini EJ, Verginelli G, Jatene AD: Valve replacement in the Heart Institute, University of Sao Paulo, Brazil. Ann Thorac Surg. 1989; 48: S41-4.
____________________
Accepted after revision:
July 29, 2006
_______________________
Correspondence address:
Dr. Eduardo José Andrade Lopes
Rua Altino Serberto de Barros, 241 / 405
Ed. Memorial Itaigara
Salvador, BA, 41850-010, Brazil
Fax: + 55 71 3351-7424
E-mail: ejalopes@terra.com.br