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Current Urology Reports

, 20:11 | Cite as

A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation

  • Soum D. Lokeshwar
  • Joshua Bitran
  • Vinayak Madhusoodanan
  • Bruce Kava
  • Ranjith RamasamyEmail author
Surgery (J Simhan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery

Abstract

Purpose of Review

Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection rates in implant surgery, focusing on antibiotic dips.

Recent Findings

Current research endorses the use of rifampin/gentamicin as the most studied combination; however, some studies have utilized different dips for additional coverage including the InhibiZone on the AMS 700.

Summary

With the increasing prevalence of diabetes and Gram-negative organisms, there is a need to develop strategies for increased coverage against infections. Controlled studies with different antibiotic combinations are needed to identify the ideal cocktail to decrease infection.

Keywords

IPPs (inflatable penile prosthesis) Antibiotic dips Penile implant infections Penile implant surgery 

Notes

Compliance with Ethical Standards

Conflict of Interest

Soum D. Lokeshwar, Joshua Bitran, and Vinayak Madhusoodanan each declare no potential conflicts of interest.

Bruce Kava is a consultant for Endo and Coloplast.

Ranjith Ramasamy is a consultant for Coloplast, an investigator for Boston Scientific and Direx, and an advisory board member and investigator for Endo and Aytu Biosciences.

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Gross MS, Phillips EA, Carrasquillo RJ, 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 This study documents a high incidence of anaerobic, Candida , and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. CrossRefGoogle Scholar
  2. 2.
    Holland B, Kohler T. Minimizing penile implant infection: a literature review of patient and surgical factors. Curr Urol. 2015;16(12):81.CrossRefGoogle Scholar
  3. 3.
    Poradzka A, Jasik M, Karnafel W, Fiedor P. Clinical aspects of fungal infections in diabetes. Acta Pol Pharm. 2013;70(4):587–96.PubMedGoogle Scholar
  4. 4.
    Dolan CT. Effect of gentamicin on growth of yeasts, yeast-like organisms, and aspergillus fumigatus. Am J Clin Pathol. 1972;57(1):30–2.CrossRefGoogle Scholar
  5. 5.
    Tucker RM, Denning DW, Hanson LH, Rinaldi MG, Graybill JR, Sharkey PK, et al. Interaction of azoles with rifampin, phenytoin, and carbamazepine: in vitro and clinical observations. Clin Infect Dis. 1992;14(1):165–74.CrossRefGoogle Scholar
  6. 6.
    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, Mckinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol. 1994;151(1):54–61.CrossRefGoogle Scholar
  7. 7.
    Le B, Burnett AL. Evolution of penile prosthetic devices. Korean J Urol. 2015;56(3):179–86.CrossRefGoogle Scholar
  8. 8.
    Gee WF. A history of surgical treatment of impotence. Urology. 1975;05:401–5.CrossRefGoogle Scholar
  9. 9.
    Carson CC. Penile prostheses: state of the art. In: Kirby RS, O'Leary MP, editors. Recent advances in urology. Edinburgh: Churchill Livingstone; 1998. p. 61–72.Google Scholar
  10. 10.
    Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology. 1973;2(1):80–2.CrossRefGoogle Scholar
  11. 11.
    Wilson SK, Delk JR. Historical advances in penile prostheses. Int J Impot Res. 2000;12(Suppl 4):S101–7.CrossRefGoogle Scholar
  12. 12.
    Henry GD. Historical review of penile prosthesis design and surgical techniques: Part 1 of a three-part review series on penile prosthetic surgery. J Sex Med. 2009;6(3):675–81.CrossRefGoogle Scholar
  13. 13.
    Bettocchi C, Palumbo F, Spilotros M, Palazzo S, Saracino GA, Martino P, et al. Penile prostheses. Ther Adv Urol. 2010;2(1):35–40.CrossRefGoogle Scholar
  14. 14.
    Carson CC 3rd. Management of prosthesis infections in urologic surgery. Urol Clin N Am. 1999;26:829–39.CrossRefGoogle Scholar
  15. 15.
    Carson CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185(2):614–8.CrossRefGoogle Scholar
  16. 16.
    Al mohajer M, Darouiche RO. Infections associated with inflatable penile prostheses. Sex Med Rev. 2014;2(3–4):134–40.CrossRefGoogle Scholar
  17. 17.
    Carson CC. Infections in genitourinary prostheses. Urol Clin N Am. 1989;16(1):139–47.Google Scholar
  18. 18.
    Costerton JW, Cheng KJ, Geesey GG, Ladd TI, Nickel JC, Dasgupta M, et al. Bacterial biofilms in nature and disease. Annu Rev Microbiol. 1987;41:435–64.CrossRefGoogle Scholar
  19. 19.
    Gross M, Greenfield J, Levine L, et al. Mp32-14 new findings regarding the timeline of microorganisms, infection severity and surgical intervention in inflatable penile prosthesis infections. J Urol. 2018;199(4):425.Google Scholar
  20. 20.
    Mckim SE, Carson CC. AMS 700 inflatable penile prosthesis with InhibiZone. Expert Rev Med Devices. 2010;7(3):311–7.CrossRefGoogle Scholar
  21. 21.
    Carson CC. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol. 2004;171(4):1611–4.CrossRefGoogle Scholar
  22. 22.
    Wolter CE, Hellstrom WJ. The hydrophilic-coated inflatable penile prosthesis: 1-year experience. J Sex Med. 2004;1(2):221–4.CrossRefGoogle Scholar
  23. 23.
    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.CrossRefGoogle Scholar
  24. 24.
    Pineda M, Burnett AL. Penile prosthesis infections-a review of risk factors, prevention, and treatment. Sex Med Rev. 2016;4(4):389–98.CrossRefGoogle Scholar
  25. 25.
    Fang M. Trends in the prevalence of diabetes among U.S. adults: 1999-2016. Am J Prev Med. 2018;55(4):497–505.CrossRefGoogle Scholar
  26. 26.
    Cotta BH, Butcher M, Welliver C, Mcvary K, Köhler T. Two fungal infections of inflatable penile prostheses in diabetics. Sex Med. 2015;3(4):339–42.CrossRefGoogle Scholar
  27. 27.
    Darouiche R, Raad I, Bodey G, Musher D. Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia: potential role of the combination of minocycline and rifampin. Int J Antimicrob Agents. 1995;6(1):31–6.CrossRefGoogle Scholar
  28. 28.
    Raad I, Darouiche R, Hachem R, Sacilowski M, Bodey GP. Antibiotics and prevention of microbial colonization of catheters. Antimicrob Agents Chemother. 1995;39(11):2397–400.  https://doi.org/10.1128/aac.39.11.2397.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mandava SH, Serefoglu EC, Freier MT, Wilson SK, Hellstrom WJ. Infection retardant coated inflatable penile prostheses decrease the incidence of infection: a systematic review and meta-analysis. J Urol. 2012;188(5):1855–60.CrossRefGoogle Scholar
  30. 30.
    •• Chanyi RM, Alzubaidi R, Leung EJY, Wilcox HB, Brock GB, Burton JP. Inflatable penile prostheses implantation: does antibiotic exposure matter? Sex Med. 2018;6(3):248–54 Immersing an IPP material into an antibiotic solution, such as ampicillin or ciprofloxacin, increases the bactericidal properties and may aid in the prevention of infection. CrossRefGoogle Scholar
  31. 31.
    Eid F. No-touch technique. J Sex Med. 2011;8:5–8.CrossRefGoogle Scholar
  32. 32.
    Henry GD, Kansal NS, Callaway M, Grigsby T, Henderson J, Noble J, et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol. 2009;181:1264–8.CrossRefGoogle Scholar
  33. 33.
    Wolf JS, Bennett CJ, Dmochowski RR, et al. Urologic surgery antimicrobial prophylaxis. American Urological Association - Urologic Surgery Antimicrobial Prophylaxis. https://www.auanet.org/guidelines/antimicrobial-prophylaxis-(2008-reviewed-and-validity-confirmed-2011-amended-2012). Published 2012. Accessed 20 Oct 2018.
  34. 34.
    • Ciftci S, Nemut T, Culha MM, et al. Non-infected penile prosthesis cultures during revision surgery; comparison between antibiotic coated and non - coated devices. Int Braz J Urol. 2016;42(6):1183–9 Positive bacterial cultures are present on non-infected penile prostheses at revision surgeries in some of the patients. Antibiotic coated prostheses have much less positive cultures than non-coated devices. CrossRefGoogle Scholar
  35. 35.
    •• Jani K, Smith C, Delk JR, et al. Infection retardant coatings impact on bacterial presence in penile prosthesis surgery: a multicenter study. Urology. 2018;119:104–8 Positive bacterial cultures have been shown to be present on clinically uninfected IPPs at time of revision surgery. Culture isolates grown from patients with IRC IPPs reveal a nontraditional bacterial profile: fewer cultured isolates of Staphylococcus genus. CrossRefGoogle Scholar
  36. 36.
    Li H, Fairfax MR, Dubocq F, et al. Antibacterial activity of antibiotic coated silicone grafts. J Urol. 1998;160(5):1910–3.CrossRefGoogle Scholar
  37. 37.
    Gonzalez LS, Spencer JP. Aminoglycosides: a practical review. Am Fam Physician. 1998;58(8):1811–20.PubMedGoogle Scholar
  38. 38.
    Hellstrom WJ, Hyun JS, Human L, Sanabria JA, Bivalacqua TJ, Leungwattanakij S. Antimicrobial activity of antibiotic-soaked, resist-coated Bioflex. Int J Impot Res. 2003;15(1):18–21.CrossRefGoogle Scholar
  39. 39.
    Rajpurkar A, Fairfax M, Li H, Dhabuwala CB. Antibiotic soaked hydrophilic coated Bioflex: a new strategy in the prevention of penile prosthesis infection. J Sex Med. 2004;1(2):215–20.CrossRefGoogle Scholar
  40. 40.
    John TT, Fairfax M, Dhabuwala CB. Inflatable penile prosthesis components – an in vitro comparative study of antibacterial activity. J Urol. 2008;179(4):340.CrossRefGoogle Scholar
  41. 41.
    Dhabuwala C, Sheth S, Zamzow B. Infection rates of rifampin/gentamicin-coated Titan Coloplast penile implants. Comparison with Inhibizone-impregnated AMS penile implants. J Sex Med. 2011;8(1):315–20.CrossRefGoogle Scholar
  42. 42.
    Dhabuwala C. In vitro assessment of antimicrobial properties of rifampin-coated Titan(®) Coloplast penile implants and comparison with Inhibizone(®). J Sex Med. 2010;7(10):3516–9.CrossRefGoogle Scholar
  43. 43.
    Wilson SK, Salem EA, Costerton W. Anti-infection dip suggestions for the Coloplast Titan inflatable penile prosthesis in the era of the infection retardant coated implant. J Sex Med. 2011;8(9):2647–54.CrossRefGoogle Scholar
  44. 44.
    Xie D, Gheiler V, Lopez I, Nehrenz GM Sr, Klopukh B, Bianco F, et al. Experience with prophylactic gentamicin during penile prosthesis surgery: a retrospective comparison of two different doses. J Sex Med. 2017;14(9):1160–4.CrossRefGoogle Scholar
  45. 45.
    Levine LA, Becher EF, Bella AJ, Brant W, Kohler T, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016;13(4):489–518.CrossRefGoogle Scholar
  46. 46.
    • King S, Gonzalez J, Goldstein I. 141 Use of dorsal nerve block with bupivacaine liposome injectable suspension (Exparel) for pain management following three-piece penile prosthesis surgery. J Sex Med. 2016;13(5). Use of dorsal nerve block with bupivacaine liposome injectable suspension (Exparel) can significantly impact long-term postoperative pain control. Google Scholar
  47. 47.
    •• Chung E. 059 Local anaesthesia eluting property of Coloplast titan penile prosthesis hydrophilic coating: an in-vitro drug elution profile and a randomized double-blind clinical outcome study. J Sex Med. 2018;15(7). Coloplast hydrophilic coating provides a promising avenue to provide adjunctive analgesia in penile prosthesis implant patient care without compromising antibacterial properties. Google Scholar
  48. 48.
    Fazio L, Brock G. Erectile dysfunction: management update. Can Med Assoc J. 2004;170(9):1429–37.CrossRefGoogle Scholar
  49. 49.
    Sunaryo PL, Colaco M, Terlecki R. Penile prostheses and the litigious patient: a legal database review. J Sex Med. 2014;11(10):2589–94.  https://doi.org/10.1111/jsm.12649.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Soum D. Lokeshwar
    • 1
  • Joshua Bitran
    • 1
  • Vinayak Madhusoodanan
    • 1
  • Bruce Kava
    • 1
  • Ranjith Ramasamy
    • 1
    Email author
  1. 1.Department of UrologyUniversity of Miami Miller School of MedicineMiamiUSA

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