54411 Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

Name of the Procedure:

Removal and Replacement of All Components of a Multi-Component Inflatable Penile Prosthesis through an Infected Field, Including Irrigation and Debridement of Infected Tissue

Summary

This surgical procedure involves removing and replacing all parts of a multi-component inflatable penile prosthesis that is in an infected area. It includes cleaning out the infection and removing damaged tissue. The goal is to treat the infection and restore the functioning of the penile prosthesis in a single surgery.

Purpose

This procedure addresses infections that occur in patients with inflatable penile prostheses. It aims to eradicate the infection, remove damaged or infected tissue, and replace the prosthesis to restore its functionality.

Indications

• Infected penile prosthesis
• Symptoms of infection such as redness, swelling, pain, or discharge around the prosthesis
• Prosthesis malfunction due to infection

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Adjustments to medications, particularly blood thinners, might be required.
• Pre-operative blood tests and imaging studies may be needed to assess the extent of the infection.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made to access the infected area and the components of the prosthesis.
3. All components of the infected prosthesis are carefully removed.
4. The infected field is thoroughly irrigated with sterile solution.
5. Debridement, or the removal of infected and dead tissue, is performed.
6. New, sterile prosthetic components are implanted.
7. The surgical site is closed with sutures and dressed appropriately.

Tools and equipment:

• Scalpels, forceps, and other standard surgical instruments
• Irrigation system
• Replacement components of the inflatable penile prosthesis
• Sterile drapes and dressing materials

Duration

The procedure typically takes between 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technicians

Risks and Complications

• Infection recurrence
• Bleeding or hematoma formation
• Damage to surrounding tissues or organs
• Anesthesia-related risks
• Mechanical failure of the new prosthesis

Benefits

• Eradication of the infection
• Restoration of erectile function
• Decreased likelihood of infection recurrence with immediate replacement

Recovery

• Typically, a hospital stay of 1-2 days post-procedure.
• Antibiotics are prescribed to prevent further infection.
• Pain management with medications as needed.
• Follow-up appointments to monitor progress and ensure proper healing.
• Patients should avoid strenuous activities and sexual intercourse for 4-6 weeks.

Alternatives

• Removal of the prosthesis without immediate replacement, followed by delayed re-implantation after the infection has completely healed.
• Conservative management with antibiotics alone, which is often insufficient for severe infections.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not experience pain.
• Post-operative pain and discomfort can be managed with prescribed medications.
• Gradual return to normal activities, with specific instructions from the healthcare team for a smooth recovery process.