Preventing Infections in Prosthetic Surgery
- 30 Downloads
Purpose of Review
Review current literature for risk factors and strategies to prevent infection in urological prosthetic implants.
Recent studies on risk factors and special patients are described. Strategies to decrease infection rate, role, and importance of biofilm is also discussed.
Infection on implanted devices for the treatment of erectile dysfunction and urinary incontinence is the most feared complication. Risk factors, where/when most infections occur, and the role of biofilm are discussed. Infection rates decreased with the advent of infection-resistant coated devices, and subsequently, bacteriological/isolate profiles changed. The bacteriology of implant infection is reviewed. Basic rules of perioperative implant prevention are ensuring no concurrent infections, proper alcohol-based skin preparation (not iodine), appropriate sterile technique, preoperative antimicrobial prophylaxis, reduced operative time, and limiting the implant from touching the skin. Future research is also discussed.
KeywordsInflatable penile prosthesis Infection Infection prevention Biofilm Revision washout
Abbreviations and Acronyms
IPPinflatable penile prosthesis
SSIsurgical site infection
Compliance with Ethical Standards
Conflict of Interest
Gerard Henry reports personal fees from Boston Scientific as an investigator and consultant, Coloplast as an investigator, Medtonic as a consultant, and MicrogenDX as an investigator and consultant, outside of submitted work.
Geraldo Macedo declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Boysen WR, Cohen AJ, Kuchta K, Park S, Milose J. Combined placement of artificial urinary sphincter and inflatable penile prosthesis does not increase risk of perioperative complications or impact long-term device survival. Urology. 2019;124:264–70. https://doi.org/10.1016/j.urology.2018.10.033.CrossRefPubMedGoogle Scholar
- 4.•• Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, Levine LA, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med. 2017;14(3):455–63. https://doi.org/10.1016/j.jsxm.2017.01.007. Analyses culture results and antibiotic resistance of a large number of infected IPPs from 25 centers and compares with current AUA and EAU guidelines for antibiotic prophylaxis. It found a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. CrossRefPubMedGoogle Scholar
- 11.• Jani K, Smith C, Delk JR 2nd, Carson CC, Donatucci CF, Cleves MA, et al. Infection Retardant Coatings Impact on Bacterial Presence in Penile Prosthesis Surgery: A Multicenter Study. Urology. 2018;119:104–8. https://doi.org/10.1016/j.urology.2018.05.028. Studied the effect of infection retardant coating on culture positive isolates found in uninfected and infected IPPs. It shows a change in bacteriological profile with IRC, fewer cultured isolates of Staphylococcus genus. CrossRefPubMedGoogle Scholar
- 18.Balen A, Gross MS, Phillips EA, Henry GD, Munarriz R. Active polysubstance abuse concurrent with surgery as a possible newly identified infection risk factor in inflatable penile prosthesis placement based on a retrospective analysis of health and socioeconomic factors. J Sex Med. 2016;13(4):697–701. https://doi.org/10.1016/j.jsxm.2016.01.010.CrossRefPubMedGoogle Scholar
- 28.•• Dawn LE, Henry GD, Tan GK, Wilson SK. Biofilm and Infectious Agents Present at the Time of Penile Prosthesis Revision Surgery: Times Are a Changing. Sex Med Rev. 2017;5(2):236–43. https://doi.org/10.1016/j.sxmr.2017.01.002. Discusses the role of biofilm in clinical infections and current changes in the bacteriology of infections. The abundance of staphylococcal species-particularly coagulase-negative organisms-in positive cultures has decreased in infected implants, and clinically uninfected implants also have shown a decrease in the proportion of staphylococcal species. Conversely, other isolates such as fungi, Escherichia coli, and Enterococcus species have increased in clinically uninfected and infected implants, and there has been an overall increase in unique isolates that form the biofilm. CrossRefPubMedGoogle Scholar
- 38.Pan S, Rodriguez D, Thirumavalavan N, Gross MS, Eid JF, Mulcahy J, et al. The use of antiseptic solutions in the prevention and Management of Penile Prosthesis Infections: areview of the cytotoxic and microbiological effects of common irrigation solutions. J Sex Med. 2019;16(6):781–90. https://doi.org/10.1016/j.jsxm.2019.03.271.CrossRefPubMedGoogle Scholar
- 41.Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31(12):1219–29. https://doi.org/10.1086/657134.CrossRefPubMedGoogle Scholar
- 44.G.Bonkat, R.Pickard, R.Bartoletti, F.Bruyère, S.E.Geerlings, F.Wagenlehner et al. EAU guidelines on urological infections. 2017.Google Scholar
- 46.Sadeghi-Nejad H, Ilbeigi P, Wilson SK, Delk JR, Siegel A, Seftel AD, et al. Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery. Int J Impot Res. 2005;17(6):535–8. https://doi.org/10.1038/sj.ijir.3901354.CrossRefPubMedGoogle Scholar
- 51.Graf K, Sohr D, Haverich A, Kuhn C, Gastmeier P, Chaberny IF. Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program. Interact Cardiovasc Thorac Surg. 2009;9(2):282–6. https://doi.org/10.1510/icvts.2009.205286.CrossRefPubMedGoogle Scholar
- 57.Henry G, Price G, Pryor M, Greenfield J, Jones L, Perito P, et al. Observation of local clinical penile prostheses infections instead of immediate salvage rescue/removal: ten center study with surprising results. Abstract #92. Proceedings of the 20(th) Annual Fall Scientific Meeting of the Sexual Medicine Society of North America, Miami Beach, USA, November 20–23, 2014. J Sex Med. 2015;12(Suppl 2):101–83. https://doi.org/10.1111/jsm.12808.CrossRefGoogle Scholar
- 58.Henry G, Price G, Pryor M, Greenfield J, Jones L, Perito P, et al. Pd20–04 Observation of Local Clinical Penile Prostheses Infections Instead of Immediate Salvage Rescue / Removal: Multicenter Study with Surprising Results. J Urol. 2014;191(4S):e1–e958. https://doi.org/10.1016/j.juro.2014.02.1694.CrossRefGoogle Scholar