Contemporary Revision Penile Prosthesis Surgery Is Not Associated with a High Risk of Implant Colonization or Infection: A Single-Surgeon Series

Abstract

Introduction Revision penile prosthesis surgery has traditionally been associated with a greater risk of postoperative infection than primary implant placement. This has been attributed to the high prevalence of asymptomatic bacteria found surrounding the implant at the time of revision surgery. Aim To validate whether contemporary revision surgery remains associated with a high risk of asymptomatic colonization and postoperative infection. Methods A comprehensive, prospective database consisting of consecutive patients undergoing primary and revision penile prosthesis surgery at our center was analyzed. Main Outcome Measures The infection risk in primary and revision implant surgery was compared. The prevalence of asymptomatic implant colonization during revision surgery, and whether this was associated with clinical infection was evaluated. The spectrum of bacterial species causing infection in this contemporary single-surgeon series was described. Results One hundred seventeen primary and 72 revision implant recipients were studied. Infection developed in four (3.4%) patients undergoing primary implants, two (4.3%) patients undergoing removal and replacement for mechanical malfunction, and three (12%) patients undergoing rerouting for extrusion (P = 0.26). Intraoperative cultures were positive in 5 (9.8%) of 51 revision patients, none of whom developed infections. Organisms causing infection included Staphylococcus aureus and Enterobacter aerogenes. Unexpectedly, an adjuvant, alcohol-based skin prep in our last 83 patients reduced the infection risk to 1.2%. Conclusions In our series, the infection risk associated with revision of malfunctioning devices was no greater than primary implant placement. Rerouting was associated with a higher infection risk, likely due to technical factors, and not implant colonization. Less than 10% of our revision implants were colonized, and this had no bearing on the development of a postoperative infection. S. epidermidis was not the most common organism implicated in device infections. Finally, our experience with an adjuvant, alcohol-based skin prep warrants further randomized prospective evaluation.

Long-Term Infection Outcomes of 3-Piece Antibiotic Impregnated Penile Prostheses Used in Replacement Implant Surgery

“…However, the organisms are suppressed by the antibiotics in M/R impregnated devices and must be recognized and cautiously monitored in clinical practice, and assessed in future research. 13,14,18,21,22 To our knowledge the strength of the data used for analysis provides the most tangible evidence to date that M/R impregnated implants are enhanced and require fewer revisions than nonimpregnated devices even in the challenging replacement surgery setting. At almost 7 years of followup of more than 11,000 replacement implant recipients secondary revision due to infection was noted in 2.5% of 9,300 men with an M/R impregnated device vs 3.7% of 1,764 with a nonimpregnated device.…”

“…17 In 2011 Kava et al reported the outcome of a prospective study in 189 patients, of whom 70 underwent implant removal/replacement/rerouting due to mechanical malfunction or extrusion. 18 Infection developed in 5 patients (7.1%) after revision, although only 57% of the procedures included washout and only approximately 70% of implants were coated or impregnated with antibiotics. In each study the infection risk associated with revision of a malfunctioning device was no greater than in the concurrent cohorts of primary implant recipients.…”

Infection Retardant Coated Inflatable Penile Prostheses Decrease the Incidence of Infection: A Systematic Review and Meta-Analysis

“…8 However, several recent reports of infection in coated devices demonstrated that bacterial species differ in coated implants, ie S. aureus and Enterobacter aerogenes. 9 After these species gain access, the bacteria attempt to adhere to the device surface and produce a protective layer of extracellular polymers, termed biofilm. 10 This layer has 2 effects.…”

Complications Associated with Retained Foreign Bodies from Infected Penile Implants: Proposal for the Use of an Implant-Specific Checklist at the Time of Device Removal

“…Interestingly, our fourth case features an entirely asymptomatic reservoir that was colonized with bacteria. This is not surprising, as 10–80% of implants undergoing revision surgery for mechanical failure harbor asymptomatic bacteria within the peri‐implant space, which may increase the risk of infection associated with revision surgery .…”