No abstract

Background: PP is a gold standard for treatment of erectile dysfunction given its reliability and efficacy.Infection remains the most feared complication of prosthetic surgery, which usually results in device removal, and places a significant economic burden on the healthcare system. While biofilms have shown to support the persistence of microorganisms, the degree by which this matrix is truly pathogenic remains unknown given its high prevalence even in asymptomatic patients. We aim to review and summarize the current literature pertaining to biofilm formation in the setting of penile prosthesis (PP) surgeries in clinically infected and non-infected cases.Methods: Searches were performed in the MEDLINE online database through PubMed using a combination of keywords "penile prosthetic" OR "penile prosthesis" OR "penile implant" AND "biofilm" OR "revision" OR "removal" OR "infection" OR "explant". Eleven articles met inclusion criteria. There were only three studies that explicitly listed the number of biofilms identified in their cohort, but we also included eight articles that mentioned swabbing and culturing of any bacterial biofilm during revision procedures for both clinically infected and non-infected implants.Results: Infected PP yielded a 11-100% rate of biofilm presence, while non-infected PP yielded a 3-70% rate of biofilm presence. Time to reoperation from initial PP placement were also largely variable, ranging from 2 weeks to over 2 years. Coagulase-negative staphylococcus (i.e., Staphylococcus epidermidis) were the most commonly reported organisms among non-infected implants, however, newer studies have identified a change towards more virulent organisms.Conclusions: Since the advent of PP surgery, diabetes control, revision washout protocols and antibioticimpregnated devices have led to an overall decrease in biofilm formation and infectious complications.There is an overall paradigm shift in microbial profiles with more virulent organisms, such as Escherichia coli, Pseudomonas aeruginosa, Enterococcus species, and even fungal species beginning to replace the more common coagulase-negative staphylococcal species, especially in clinically infected implants. Additional studies are necessary to define the significance of bacterial presence in biofilms using impactful technologies such as next-generation sequencing. Currently, preliminary and experimental biofilm-control strategies are also underway to further address this clinical issue.

Background: Treatment progression for men on active surveillance (AS) for prostate cancer (PCa) is driven primarily by grade and volume progression on isolated prostate biopsies (PBx). As PCa is a multifocal disease, regional disease progression over time should be accounted for. Objective: To validate the utility of the Cumulative Cancer Location (CCLO) metric, which assesses regional core involvement, as described by Erickson et al., in predicting AS outcomes in a North American cohort. Design, setting, and participants: Single institutional retrospective chart review of all AS patients evaluated between 2015-2017. Outcome Measurements and Statistical Analysis: CCLO defined as total number of cancerpositive sextant locations among all PBx to that point in time (range 1-6). Baseline demographics and clinical characteristics of the entire cohort were stratified by CCLOΔ, defined as the difference between the first and last CCLO. CCLOΔ then correlated to progression to treatment and treatment outcomes. Results: 261 men met inclusion criteria. Though mean number of biopsies was slightly higher in the CCLOΔ 3-5 cohort than the CCLOΔ 0-2 cohort (p=0.006), mean AS follow-up time (3.3 years) was not significantly different (p=0.327). As CCLOΔ increased, the proportion of men remaining on AS decreased while the proportion of men receiving treatment increased (p<0.001). In men undergoing radical prostatectomy, higher CCLOΔ was not associated with higher rates of Gleason 7-10 (p=0.38) or pT3 (p=0.52) disease. However, as CCLOΔ increased, upgrading from final PBx to RP pathology increased while downgrading decreased (p=0.12). In Kaplan-Meier analyses, lower CCLOΔ and lower initial CLO score were associated with the highest 5-year treatment-free survival rates (p<0.001). Conclusion: Higher regional cancer core involvement is associated with higher rates of progression to treatment in AS patients. The CCLO metric is a potentially useful modality in stratifying patients for treatment in AS patients among the North American cohort, while not compromising disease outcomes.

No abstract