A Proactive Measure Against Corporal Scarring Following Penile Implant Infection and Extraction: Mitomycin-C

Author: Prof.Osama Shaeer: Professor of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Egypt

Key Words: Corporal scarring, Corporal fibrosis, Penile prosthesis infection, penile prosthesis extrusion, penile prosthesis explantation, scarred corporal bodies

Introduction
The classic and most common approach to penile implant infection is implant extraction and delayed implantation after resolution of infection (1). Fibrous tissue occludes the corpora cavernosa resulting in a difficult and risky re-implantation.

Several methods and specialized insturments have been developed to allow re-implantation despite the tough fibrous tissue. Still, the procedure is very challenging. Even if successful, the implant is commonly shorter and narrower. Mitomycin-C is an anti-tumor antibiotic with high efficacy against fibrous tissue development. Instillation of Mitomycin-C upon explantation can prevent corporal scarring of the cavity where the cylinders resided.

Case presentation
A case of infected malleable penile implant presented to our practice. Total implant length was 20cm, and girth 13.

Protocol
The implant was extracted. Corporal spaces were washed with Povidone Iodine, Hydrogen Peroxide, Vancomycin and Gentamycin. Patient was re-scrubbed and re-draped. Mitomycin-C 10mg was reconstituted in 250cc saline, half of which was instilled into each corporal space. Contact with extra-cavernous tissue was avoided. Corporotomy and skin edges were freshened before closing.

Three months later, implantation of a replacement prosthesis was attempted. Simple dilation of the corporal spaces was performed using blunt Hegar dilators only.

Outcome
Dilatation of the corporal spaces met little resistance. No force or sharp dissection were required. A malleable prosthesis was implanted, length 19, girth 13. No complications were encountered.

Discussion
The anti-fibrotic effect of Mitomycin-C has been of value in glaucoma surgery, and in treatment of urethral strictures and esophageal strictures. An intradermal hypersensitivity test is recommended, as well as observing the contraindications and rare -though possible- side effects reported in medical literature.

Application of Mitomycin-C into the corporal spaces upon removal of an infected penile implant ameliorates fibrosis. Prevention of corproral scarring allows low-risk re-implantation, and preserves penile size. In addition to the CaSo4 cast (2), this is among the first proactive measures against corporal scarring, neutralizing one of the most difficult challenges in prosthetic urology: penile prosthesis implantation in scarred corpora cavernosa.

Acknowledgement: None

Disclosures: None

References:

  1. Zargaroff S, Sharma V, Berhanu D, Pearl JA, Meeks JJ, Dupree JM, Le BV, Cashy J, McVary KT. National trends in the treatment of penile prosthesis infections by explantation alone vs. immediate salvage and reimplantation. J Sex Med. 2014

    Apr;11(4):1078-1085.

  2. Swords K, Martinez DR, Lockhart JL, Carrion R. A preliminary report on the usage of an intracorporal antibiotic cast with synthetic high purity CaSO4 for the treatment of infected penile implant. J Sex Med. 2013 Apr;10(4):1162-9.