(005) Novel Use of Stimulan Antibiotic Cast as Corporal Spacer for Infection Post Failed Penoscrotal Decompression in Ischemic Priapism Prior to Penile Prosthesis

Introduction Ischaemic priapism refractory to therapeutic aspiration, adrenergic agonists and distal shunting is a challenge to the urologists. The timing of imminent penile prosthesis insertion due to evolving corporal fibrosis is crucial. This situation can be compunded further with the presence of corporal infection, which we encountered following a failed peno-scrotal decompression (PSD). We present a unique approach of insertion of antibiotic- coated calcium sulphate casts (Stimulan™) into the corpora cavernosa, to act as an antibiotic delivery spacer for approximately 4 weeks followed by penile prosthesis insertion Objective to show a novel safe and possible option that can be offered to patient suffering from infected priapism Methods We display the surgical approach to the insertion of Stimulan into the corpora cavernosa, as a bridging step to penile prosthesis insertion following ischaemic priapism in a 44-year old male. The use of Stimulan was approved following institutional board review. Peno-scrotal incision was performed for corporal access, proximal to the previous PSD corporotomies. Vancomycin and Gentamicin wash of the copora was performed as standard, with XR-guided delivery of eight 11mm calibre Stimulan beads to each corpora. The patient underwent baseline serum electrolyte and XR penis studies and weekly until penile prosthesis insertion. 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 18 (or 21?) and this guided timing of penile prosthesis insertion. Conclusions The use of Stimulan™ in the corpora cavernosa appears clinically safe and a potential bridging option in men with ischaemic priapism awaiting imperitive penile prosthesis, by ensuring corporal space is maintained with parallel intra-corporal antibiotic delivery. We propose the expansion of the use of Stimulan in high-risk clinical cases such the post-priapism setting. Disclosure No