SURGEONS CORNER Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion Osama Shaeer, MD, PhD, 1,2 Kamal Shaeer, MD, 1,2 and Islam Fathy Soliman AbdelRahman, MD, MRCS, FECSM, FEAA, FACS 1,2 ABSTRACT Introduction: When a penile prosthesis is implanted, a fibrous tissue capsule gradually forms around it. In case of penile prosthesis infection, salvage and immediate reimplantation into the same capsule that envelops the infected prosthesis is a trial to avoid the difficulty and shortening encountered with explantation and delayed reimplantation. Aim: We propose that, on salvage, the infected prosthesis be explanted, the capsule washed out and then abandoned, and the replacement prosthesis implanted in the extracapsular sinusoidal space, between the capsule and tunica albuginea. This aims at decreasing contact between the replacement implant and the pyogenic membrane in the capsule. Methods: This study was performed in a tertiary implantation center, involving 20 prospective cases referred with either an infected implant or pump erosion. Through a penoscrotal incision, lateral corporotomies were performed by superficial cuts, in a trial to identify the extracapsular sinusoidal space before opening the capsule. The capsule was then opened. All components of the implant were explanted, and the capsules were washed out. The extracapsular space within the corpora cavernosa was developed between the capsule and the tunica albuginea by sharp dissection initially, then bluntly dilated with a Hegar dilator. A malleable penile prosthesis was implanted in the extracapsular space bilaterally. Main Outcome Measures: The reinfection rate was evaluated though 7e38 months after surgery. Results: We were able to identify and dilate the extracapsular space in 18 of 20 cases. Reinfection occurred in 1 case (1 of 18, 5.6%). Development of the extracapsular space added approximately 10 minutes to the operative time. Clinical Implication: If salvage of an infected penile implant can be delayed until capsule maturation, extrac- apsular implantation may decrease the reinfection rate. Strength & Limitations: The limitations are the lack of a control group of intra-capsular classic salvage and the relatively limited sample number. Conclusion: On penile prosthesis salvage surgery, whether for infection or extrusion, implantation of the replacement prosthesis in the extracapsular sinusoidal tissue is associated with low infection rates, because it bypasses the capsule, which may still harbor bacterial contamination despite the wash-out. Shaeer O, Shaeer K, AbdelRahman IFS. Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion. J Sex Med 2019;XX:XXXeXXX. Copyright Ó 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Penile Prosthesis Infection; Pump Erosion; Penile Prosthesis Extrusion; Penile Prosthesis Salvage; Mulcahy Washout INTRODUCTION Infection is 1 of the most serious sequelae of penile prosthesis implantation surgery, indicating explantation. Options for cases with definitive infection include explantation and delayed reim- plantation, weeks after resolution of infection, or immediate salvage and reimplantation. In salvage procedures, all components of the device are removed from the surrounding fibrous tissue capsule that forms around any foreign object implanted in vivo. Mechanical lavage and irrigation with antimicrobial/antiseptic Received December 9, 2018. Accepted February 5, 2019. 1 Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Egypt; 2 Kamal Shaeer Hospital, Giza, Egypt Copyright ª 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jsxm.2019.02.005 J Sex Med 2019;-:1e5 1