(229) The Use of Calcium Sulphate (Stimulan ™) in Penile Prosthetics as a Corporal Antibiotic-Delivering Spacer: Early Case Series

Introduction The management of penile prosthesis infection, priapism and their downstream implications for corporal fibrosis and re-implantation is a significant challenge to the andrologist. Any bridge to alter the risk of further infection or presence of fibrosis is therefore of great interest to the surgeon and patient. The use of calcium sulphate beads (Stimulan ™), impregnated with antibiotics is a commonplace treatment in the field of orthopaedics for managing joint cavity infection following prosthesis removal. Stimulan ™ biodegrades whilst eluting its antibiotic coating into the surgical space as it dissolves, making it an attractive concept also in the field of penile prosthetics as both a potential spacer and long-term, safe antibiotic delivering material. Its use in penile prosthesis infection has been described by Carrion, but not in the setting of priapism. Objective The purpose was to investigate feasibility, safety and practical clinical utility of Stimulan ™ insertion and to gain understand timing of intra-corporal Stimulan ™ dissoloution. We used Stimulan ™ in the case of two men with high-risk corpora. Methods In the first case, a 48 year-old male developed superficial wound dehissence and intra-corporal collection and early fibrosis suggested on MRI following multiple failed interventions for ischaemic priapism, including peno-scrotal decompression. In the second case, a 65yo male presented with inflatable penile prosthesis infection eroding through the scrotum and glans. In both cases, Stimulan ™ was prepared with gentamicin and vancomycin, and inserted into the corpora cavernosa using XR guidance and serum biochemistry, clinical and radiological follow-up. Results Both patients remained pain free and well without any hypercalcaemia. Complete Stimulan ™ dissolution seems to occur from week 2-3 within the corpora in our small case series, according to intra-operative and radiological findings. In the patient with Stimulan ™ insertion following prosthesis infection and explanation, there was clinical evidence of Stimulan leaking through the glans on day 10, without any soft tissue or wound infection. In the case of priapism, inflatable penile prosthesis was performed sucesfuly day 28 following Stimulan™ insertion. Conclusions Early post-operative follow-up suggests use of Stimulan™ in the corpora cavernosa appears feasible, safe and a potential bridging option for surgeons aiming to avoid further infective complications in the setting of priapism or prosthesis-related infection. To our knowledge this is the first described use of Stimulan ™ in the penis in the UK. In order to define if the optimal use of Stimulan ™ as a true corporal spacer exists, an accurate understanding of material dissoloution timing, to guide ideal timing for re-intervention is required. 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