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IMPROVED INFECTION OUTCOMES AFTER MULCAHY SALVAGE PROCEDURE AND REPLACEMENT OF INFECTED IPP WITH MALLEABLE PROSTHESIS
Martin S. Gross, MD1, J. Francois Eid, MD2, Daniel Martinez, MD3, Rafael Carrion, MD3, Paul Perito, MD4, Laurence Levine, MD5, Jason Greenfield, MD6, Ricardo Munarriz, MD1.
1Boston University Medical Center, Boston, MA, USA, 2Advanced Urological Care, New York City, NY, USA, 3University of South Florida, Tampa, FL, USA, 4Perito Urology, Coral Gables, FL, USA, 5Rush University Medical Center, Chicago, IL, USA, 6Urology Associates of North Texas, Arlington, TX, USA.
Introduction: Since its introduction in 1996, Mulcahy salvage has significantly improved outcomes for removal and replacement of infected IPPs. Long-term follow-up data of Mulcahy salvage shows an infection-free rate of 82%. Since 2002, 45 patients have undergone Mulcahy salvage with IPP removal and replacement with malleable prosthesis at our institutions. Of these patients, 43 (95.5%) have remained infection free postoperatively. Additionally, 12 of these 43 patients have undergone subsequent malleable replacement with IPP.
Materials & Methods: This is a retrospective multi-institution study of 45 patients who underwent Mulcahy salvage with IPP removal and replacement with malleable prosthesis. Patients’ operative notes and charts were extensively reviewed to compile study data.
Results: Between 2002 and 2013, 45 patients underwent infected IPP removal and replacement with malleable prosthesis via Mulcahy salvage. Average age was 43, range 26 to 71. Average operative time was 157 minutes, range 110 to 209. Postoperative follow-up ranged from 2 weeks to 84 months. Thirty-one of 43 patients retained malleable prosthesis, 12 patients subsequently underwent replacement with IPP. This occurred on average 8 months after Mulcahy salvage, range from 2 to 29 months. Two patients had persistent infection after Mulcahy salvage with malleable and underwent explant.
Conclusion: Mulcahy salvage procedure and replacement of IPP with malleable prosthesis has an improved infection-free rate of 95.5% when compared to the 82% infection-free rate after IPP removal and replacement. Additionally, 12 of the 43 patients who remained infection free were able to successfully undergo subsequent removal of malleable prosthesis and replacement with IPP an average of 8 months later.
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