(359) Use of Stimulan ™ as a Corporal Antibiotic-Delivering Spacer Following Inflatable Penile Prosthesis Explantation for Infection

Introduction The infected, extruding inflatable penile prosthesis presents a surgical challenge. Subsequent corporal fibrosis and risk of further infection is significant. We present a novel approach of insertion of antibiotic-coated, calcium sulphate casts (Stimulan™) into the corpora cavernosa, to act as an antibiotic delivery spacer in a case of a man presenting with an extruded three-piece inflatable prosthesis requiring explantation. Objective The use of Stimulan ™ in surgical cavities in the field of orthopaedics is common, with the material expected to biodegrade within 60 days. We display the surgical approach to the insertion of Stimulan into the corpora cavernosa, as a bridging step to revision penile prosthesis in a 65 year-old gentleman presenting with an infected inflatable prosthesis extruding from the scrotum and peri-erosion to the glans, 12 years following insertion. Methods We removed the penile prosthesis through a standard peno-scrotal approach with separate incision to remove the retropubic reservoir. Vancomycin and Gentamicin wash of the copora was performed as standard, with placement of vancomycin & Gentamicin coated Stimulan ™ beads into the corporal cavernosal cavity. The patient underwent baseline serum electrolyte and XR penis studies post-operatively to guide understanding of Stimulan degradation and timing of next surgical intervention. Results The patient remained pain free and well without any hypercalcaemia. The Stimulan was noted to be less radio-opaque on surveillence imaging on day 10, with clinical evidence of Stimulan leaking through the glans on day 15 without any soft tissue or wound infection. Conclusions The use of Stimulan™ in the corpora cavernosa appears clinically safe and a potential bridging option in men undergoing penile prosthesis explantation for infection, by ensuring corporal space is maintained with parallel intra-corporal antibiotic delivery. We propose the use of Stimulan is feasible in high-risk cases for infection and fibrosis, and propose careful expansion of the indications for use, to investigate its maximal clinical utility. Disclosure No