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Infection Prevention Considerations for Complex Penile Prosthesis Recipients

  • Surgery (J Simhan, Section Editor)
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Abstract

Purpose of Review

The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients.

Recent Findings

Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients. Substance abuse is correlated with increased risk of infection after penile implant surgery. Careful patient selection and preoperative optimization can reduce infection risk in spinal cord injury patients.

Summary

In the last 5 years, there have been several important studies investigating the risk of penile prosthesis infection in complex patients, clarifying which patient categories are at increased risk and how that risk can be mitigated.

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References

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

  1. Goetz A, Yu VL, O'Donnell WF. Surgical complications related to insertion of penile prostheses with emphasis on infection and cost. Infect Control Hosp Epidemiol. 1988;9(6):250–4.

    CAS  PubMed  Google Scholar 

  2. Chason J, Sausville J, Kramer AC. Penile prosthesis implantation compares favorably in malpractice outcomes to other common urological procedures: findings from a malpractice insurance database. J Sex Med. 2009;6(8):2111–4.

    PubMed  Google Scholar 

  3. Loeffler RA, Sayegh ES. Perforated acrylic implants in management of organic impotence. J Urol. 1960;84:559–61.

    CAS  PubMed  Google Scholar 

  4. Al Mohajer M, Darouiche RO. Infections associated with inflatable penile prostheses. Sex Med Rev. 2014;2(3–4):134–40.

    PubMed  Google Scholar 

  5. Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med. 2007;4(4 Pt 1):1074–9.

    PubMed  Google Scholar 

  6. Serefoglu EC, Mandava SH, Gokce A, Chouhan JD, Wilson SK, Hellstrom WJ. Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med. 2012;9(8):2182–6.

    CAS  PubMed  Google Scholar 

  7. • Mirheydar H, Zhou T, Chang DC, Hsieh TC. Reoperation rates for penile prosthetic surgery. J Sex Med. 2016;13(1):129–33. This larger longitudinal study identified patient groups with increased rates of penile prosthesis reoperation and called to attention deficiencies in our ability to capture complications data.

    PubMed  Google Scholar 

  8. Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996;156(2 Pt 1):402–4.

    CAS  PubMed  Google Scholar 

  9. Welliver RC, Hanerhoff BL, Henry GD, Köhler TS. Significance of biofilm for the prosthetic surgeon. Curr Urol Rep. 2014;15(6):411.

    PubMed  Google Scholar 

  10. Eid JF, Wilson SK, Cleves M, Salem EA. Coated implants and “no touch” surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%. Urology. 2012;79(6):1310–5.

    PubMed  Google Scholar 

  11. O’Rourke TK, Erbella A, Zhang Y, et al. Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction. Transl Androl Urol. 2017;5:832–48.

    Google Scholar 

  12. •• 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. This is the only studied published to date that specifically analyzes and identifies polysubstance abuse as a risk factor for penile prosthesis infection.

    PubMed  Google Scholar 

  13. •• Li K, Brandes ER, Chang SL, Leow JJ, Chung BI, Wang Y, et al. Trends in penile prosthesis implantation and analysis of predictive factors for removal. World J Urol. 2018. This large cross-sectional database study identified HIV-positive status as a risk factor for penile prosthesis infection .

  14. •• Habous M, Tal R, Tealab A, Soliman T, Nassar M, Mekawi Z, et al. Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection. BJU Int. 2018;121(2):293–300. This multicenter prospective study confirmed that poorly controlled diabetes is a more specific risk factor for penile implant infection and identified a hemoglobin A1C threshold above which the risk increased significantly.

    CAS  PubMed  Google Scholar 

  15. Wilson SC, Delk JI. Hematoma formation following penile prosthesis implantation: to drain or not to drain. J Urol. 1996;55:634A.

    Google Scholar 

  16. Selph JP, Carson CC. Penile prosthesis infection: approaches to prevention and treatment. Urol Clin N Am. 2011;38(2):227–35.

    Google Scholar 

  17. Wilson SK, Delk JR. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995;153(3 Pt 1):659–61.

    CAS  PubMed  Google Scholar 

  18. Wilson SK, Costerton JW. Biofilm and penile prosthesis infections in the era of coated implants: a review. J Sex Med. 2012;9(1):44–53.

    PubMed  Google Scholar 

  19. Henry GD, Wilson SK, Delk JR, Carson CC, Silverstein A, Cleves MA, et al. Penile prosthesis cultures during revision surgery: a multicenter study. J Urol. 2004;172(1):153–6.

    PubMed  Google Scholar 

  20. •• 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. This larger multicenter study examined the flora culture in salvage procedures and revealed the increasing importance of anaerobes and fungal pathogens in penile prosthesis infections.

    PubMed  Google Scholar 

  21. Mulcahy JJ. Penile prosthesis infection: progress in prevention and treatment. Curr Urol Rep. 2010;11(6):400–4.

    PubMed  Google Scholar 

  22. Kumar R, Nehra A. Dual implantation of penile and sphincter implants in the post-prostatectomy patient. Curr Urol Rep. 2007;8(6):477–81.

    PubMed  Google Scholar 

  23. Wilson S, Delk J, Henry GD, Siegel AL. New surgical technique for sphincter urinary control system using upper transverse scrotal incision. J Urol. 2003;169(1):261–4.

    PubMed  Google Scholar 

  24. Kendirci M, Gupta S, Shaw K, Morey A, Jones L, Hakim L, et al. Synchronous prosthetic implantation through a transscrotal incision: an outcome analysis. J Urol. 2006;175(6):2218–22.

    PubMed  Google Scholar 

  25. •• Segal RL, Cabrini MR, Harris ED, Mostwin JL, Bivalacqua TJ, Burnett AL. Combined inflatable penile prosthesis-artificial urinary sphincter implantation: no increased risk of adverse events compared to single or staged device implantation. J Urol. 2013;190(6):2183–8. This large study of combined surgery for penile prosthesis and artificial urinary sphincter identified no increased risk of prosthesis infection compared to single implant surgery.

    PubMed  Google Scholar 

  26. Sellers CL, Morey AF, Jones LA. Cost and time benefits of dual implantation of inflatable penile and artificial urinary sphincter prosthetics by single incision. Urology. 2005;65(5):852–3.

    PubMed  Google Scholar 

  27. Wieser K, Zingg PO, Betz M, Neubauer G, Dora C. Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg. 2012;132(7):1037–44.

    PubMed  Google Scholar 

  28. Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res. 2015;473(7):2402–12.

    PubMed  PubMed Central  Google Scholar 

  29. Eka A, Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med. 2015;3(16):233.

    PubMed  PubMed Central  Google Scholar 

  30. Sendi P, Banderet F, Graber P, Zimmerli W. Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Inf Secur. 2011;63(1):17–22.

    Google Scholar 

  31. Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med. 2005;353(18):1945–54.

    CAS  PubMed  Google Scholar 

  32. Collazo-Clavell ML, Clark MM, McAlpine DE, Jensen MD. Assessment and preparation of patients for bariatric surgery. Mayo Clin Proc. 2006;81(10 Suppl):S11–7.

    PubMed  Google Scholar 

  33. Cuellar DC, Sklar GN. Penile prosthesis in the organ transplant recipient. Urology. 2001;57(1):138–41.

    CAS  PubMed  Google Scholar 

  34. •• Sun AY, Babbar P, Gill BC, Angermeier KW, Montague DK. Penile prosthesis in solid organ transplant recipients-a matched cohort study. Urology. 2018;117:86–8. This controlled study demonstrated that transplant recipients are not at increased risk of penile prosthesis infection compared to non-transplant patients despite immunosuppression.

    PubMed  Google Scholar 

  35. Bishop JR, Moul JW, Sihelnik SA, Peppas DS, Gormley TS, McLeod DG. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992;147(2):386–8.

    CAS  PubMed  Google Scholar 

  36. Mulcahy JJ, Carson CC. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60(1):167–72.

    PubMed  Google Scholar 

  37. Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int. 2006;97(1):129–33.

    PubMed  Google Scholar 

  38. Montague DK, Angermeier KW, Lakin MM. Penile prosthesis infections. Int J Impot Res. 2001;13(6):326–8.

    CAS  PubMed  Google Scholar 

  39. Wilson SK, Carson CC, Cleves MA, Delk JR. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol. 1998;159(5):1537–9 discussion 9-40.

    CAS  PubMed  Google Scholar 

  40. 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.

    PubMed  PubMed Central  Google Scholar 

  41. Zermann DH, Kutzenberger J, Sauerwein D, Schubert J, Loeffler U. Penile prosthetic surgery in neurologically impaired patients: long-term followup. J Urol. 2006;175(3 Pt 1):1041–4 discussion 4.

    PubMed  Google Scholar 

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Correspondence to Robert J. Carrasquillo.

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Robert J. Carrasquillo and Ricardo M. Munarriz each declare no potential conflicts of interest.

Martin S. Gross is a consultant and investigator for Coloplast.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Carrasquillo, R.J., Munarriz, R.M. & Gross, M.S. Infection Prevention Considerations for Complex Penile Prosthesis Recipients. Curr Urol Rep 20, 12 (2019). https://doi.org/10.1007/s11934-019-0875-7

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