Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

Abstract

Introduction A clear set of guidelines has not been defined in the use of antibiotics in penile prosthesis implantation. Aim We surveyed urologists throughout the United States to determine current practice patterns regarding antibiotic use in primary and revision penile prosthesis surgery. Methods Fifty-two Sexual Medicine Society of North America (SMS) member urologist and 164 non-SMS member urologist responses were obtained. Main Outcome Measures The survey contained 10 questions regarding antibiotic selection for primary and revision inflatable penile prosthesis (IPP) implantation. Results One hundred percent of responders in both groups utilize intraoperative antibiotics, most commonly vancomycin and gentamicin in both groups. Of SMS members, 94% prescribed postoperative home oral antibiotics in contrast to 88% of non-SMS members (P =0.3). Among SMS members, the most common antibiotic prescribed postoperatively was levofloxacin 500 mg daily while among non-SMS members, the most common antibiotic postoperatively was cephalexin 500 mg 2–4 times daily. Of SMS members, antibiotic irrigation intraoperatively occurred with 100% and with 92% of non-SMS members (P =0.04). Thirty-seven percent SMS physicians and 15% non-SMS physicians made modifications of intraoperative and postoperative antibiotics for high-risk patients (P =0.001). In the circumstance of revision of a clinically noninfected IPP, 23% SMS and 16% non-SMS member physicians utilized additional antibiotics/treatment (P =0.3). Sixteen of those surveyed admitted that they had been approached by their institution about their antibiotic use and asked to change. In the past 5 years, 29% surveyed have changed their practice patterns in antibiotic use. Conclusions There is significant difference between practice patterns of SMS and non-SMS urologists in terms of antibiotic irrigation usage, modifications for high-risk patients, and consensus about the importance of antibiotic use with Coloplast Titan implant (Coloplast, Minneapolis, MN, USA). A significant lack of uniformity exists among urologists performing prosthetic surgery with regard to antibiotic protocols. A standard set of guidelines may prove useful to implanters.

Perioperative Prevention of Penile Prosthesis Infection: Practice Patterns among Surgeons of SMSNA and ISSM

“…A recent study focused on the antibiotic practice patterns of surgeons who insert penile implants as assessed by a 10‐question mailed survey demonstrated a marked variation among urologists [29]. Our results are concordant with this lack of uniformity in antibiotic practice patterns of implant surgeons.…”

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

“…Further, use of intraoperative IV antibiotic, antibiotic solution, and postoperative antibiotics are variable among studies. Because there are no universal guidelines for perioperative antibiotic use, there is significant variability among general urologists and urologists specializing in penile prosthesis insertion ( 23 ). The senior author utilizes intravenous vancomycin and gentamicin administered immediately preoperatively, vancomycin/gentamicin solution intraoperatively, and ciprofloxacin postoperatively.…”

“…In addition, solutions containing such antibiotics as neosporin, nafcillin/gentamicin, or cephalosporin were utilized ( 18 ). Although antibiotic selection varies widely between surgeons ( 23 ), it appears that removal of all device components with operative field washout may portend the greatest benefit in preventing post-operative infection following revision surgery for device malfunction.…”

Medical pre-operative considerations for patients undergoing penile implantation

“…Acceptable alternative antibiotics include ampicillin/ sulbactam , ticarcillin/clavulanate, and piperacillin / tazobactam for less than 24 hours if no previous bacterial colonization. Survey data among implanters shows significant variety of first choice preoperative antibiotics ( 35 ). When there is no contraindication we use Vancomycin 1 g and Gentamicin 160 mg IV.…”