Inflatable Penile Implant Infection: Predisposing Factors and Treatment Suggestions

Wilson, Steven K.; Delk, John R.

doi:10.1016/s0022-5347(01)67678-x

Cited by 213 publications

(132 citation statements)

References 13 publications

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“…11 In recent literature, revision surgery infectious complications have been noted to be around 5-18%. 6,[12][13][14][15] In the face of infection, the surgeon must remove the prosthesis and in the majority of cases allow adequate time before replacement. Several studies have showed that using an antiseptic washout with an antibiotic-coated IPP significantly reduced infection during revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction?

Caire

Boonjindasup

2011

Int J Impot Res

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To analyze the reason for replacement, revision and overall satisfaction of a cohort who underwent surgical replacement of an inflatable penile prosthesis (IPP). A cohort of 105 patients who underwent IPP replacement from 2005-2007 was retrieved from the prosthesis database. Approximately 21.9% (23) underwent replacement or revision of their prosthesis because of complications, and were further analyzed. Reason for removal was stratified into infectious and non-infectious (erosion, non-function and patient discomfort). Age, race (African American vs nonAfrican American), smoking history, hypertension, diabetes, coronary artery disease and hyperlipidemia were stratified by reason for removal. Finally, we contacted patients and recorded subjective satisfaction with their IPP. The reason for removal was most commonly because of a nonfunctional IPP (47.8%), followed by infection (30.4%), erosion (17.4%) and patient discomfort (4.3%). Age and race did not show a significant difference when analyzing reason for replacement (P40.05). Patients who were smokers (P ¼ 0.907) had hypertension (P ¼ 0.554), diabetes (P ¼ 0.591) or hyperlipidemia (P ¼ 0.219) did not have significantly higher infection rates. Approximately 58.3% were satisfied with their prosthesis, 75% would have the surgery performed again and 91.7% would still recommend prosthesis surgery. Device malfunction was the primary reason for replacement/removal at our institution. Despite the complications of prosthesis reoperation, the majority of patients were still satisfied with their prosthesis, would have the surgery performed again and would recommend prosthesis surgery to a friend.

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Section: Discussionmentioning

confidence: 99%

Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction?

Caire

Boonjindasup

2011

Int J Impot Res

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“…Esta incidência gira em torno de 6,6% após acompanhamento de um ano (4), sendo de 1,8% para primeira implantação e de 13,3% para procedimentos de revisão. Em diabéticos, esta porcentagem de infecção é ainda maior, chegando a 3% após uma primeira cirurgia (5). Além do risco aumentado de infecções, existe preocupação, pois a reoperação para colocação de nova prótese é mais difí-cil e usualmente traz piores resultados.…”

Section: Discussionunclassified

Eficácia e segurança da prótese peniana inflável no tratamento de disfunção erétil em pacientes diabéticos

Arap

Rocha

Góes

et al. 2000

Arq Bras Endocrinol Metab

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A microangiopatía e a neuropatia periférica são dois dos principais fatores envolvidos na patogenia da disfunção erétil em pacientes com diabetes mellitus (DM), Os pacientes diabéticos com disfunção erétil grave têm resultados pobres com o uso de drogas orais, sendo que o tratamento fica restrito a injeções íntracavernosas e à colocação de próteses penianas na maioria dos casos. Neste grupo de pacientes o risco de infecções relacionadas à baixa imunidade gerada pelo DM traz preocupações em relação à perda da prótese e mesmo à segurança do tratamento. Analisamos prospectivamente o tratamento de cinco pacientes diabéticos insulino-dependentes através da colocação de prótese peniana inflável modelo AMS 700 CX. Os cinco pacientes apresentaram boa evolução pós-operatória e nenhum deles apresentou infecções relacionadas à cirurgia. Todos exercem atividade sexual regular. O estudo mostrou que o tratamento da disfunção erétil em diabéticos pode ser feito com segurança através do uso de próteses penianas infláveis, proporcionando uma atividade sexual adequada, sem complicações infecciosas em período de seguimento máximo de 14 meses. ABSTRACTMany factors lead to erectile dysfunction in the diabetic patient. Neuropathy and microangiopathy are involved in loss of potency in this group of patients. Diabetic patients with erectile dysfunction who have failed clinical treatment are candidates to intracavernosal injections or penile prosthesis. In these cases the risk of infection related to poor immunity cause concerns related to prosthesis loss and treatment security. We analyzed prospectively the evolution of five diabetic patients with erectile dysfunction treated by inflatable penile prosthesis implant (AMS 700 CX). All cases received prophylactic antibiotics and had the same surgical approach. We had no complications in the post-op period and no infections were seen. All patients have satisfactory regular sexual activity. The study shows that treating erectile dysfunction in the diabetic patient by inflatable penile prosthesis implant is a safe procedure. RECENTEMENTE,A INTRODUÇÃO DO sildenafil e da fentolamina revolucionou o tratamento da disfunção erétil, trazendo novas possibilidades a pacientes que não obtinham resultados com os métodos usados até

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“…10 This loss of tissue following infections can make reimplantation difficult if not impossible. In rare cases, prosthesis infections can result in penile and genital gangrene that can result in penile loss.…”

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confidence: 99%

“…Patients undergoing a reimplantation procedure have a 10% risk of infection, while patients undergoing prosthesis revision have an infection risk of 13.3%. 10,15 Individuals with diabetes are more prone to many types of infections because diabetes causes alterations in individuals' biologic defense mechanisms by impairing white blood cell function. 16 Diabetes also causes significant blood vessel damage, particularly to small blood vessels, which hampers wound healing further increasing the likelihood of infection.…”

mentioning

confidence: 99%

“…8,19 High rates of infection are seen in spinal cord injury patients ranging from 9 to 30% 10,20 while patients using chronic steroids (steroids suppress inflammation and the immune system) have an infection risk of 50%. 10 Lastly, extended surgical procedures such as penile modeling over a prosthesis for Peyronie's disease and surgical procedures such as hernia repair concurrent with prosthesis placement also increase the risk of infection. 15 In order to understand penile prosthetic infections and the mechanisms used to fight them, it is essential to have at least a rudimentary knowledge of the bodies' own defense mechanisms.…”

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confidence: 99%

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Bacterial Biofilms and implantable prosthetic devices

Silverstein

Donatucci

2003

Int J Impot Res

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Erectile dysfunction afflicts millions of men. A group of patients with advanced degeneration of their erectile tissue do not respond to pharmacological therapy, and surgical prosthetic reconstruction represents an attractive and highly satisfying alternative. Yet many men are unwilling to take this step due to fear of infection. Implanted prosthetic devices are at risk for infection because they provide a platform for the development of a bacterial biofilm, an organized bacterial colony that grows on the surface of the implanted material. The biofilm is resistant to all efforts to eradicate it short of removal of the foreign material. Bacteria may attach to the surface of the foreign material by surface charge attraction, hydrophilic/hydrophobic interactions, and by specific attachment by fimbrae. Growth, colonization, and maturation follow bacterial attachment. A mature biofilm is composed of three layers: a linking film binding the biofilm to the surface; a base film made up of a compact layer of bacteria; and a surface film from which free-floating bacteria can arise and spread. The majority of the surface layer is made up of exopolysaccharide matrix. Bacteria deep within the biofilm matrix live in a protected environment; diffusion of antibiotics is difficult, low oxygen tension leads to a lower bacterial metabolic rate rendering the bacteria functionally resistant to high levels of antibiotics. Effective strategies to reduce prosthetic infection levels must rely on the prevention of biofilm formation through surface modification. Possible mechanisms include the addition of antimicrobials to the surface of the device, or chemical modifications, which reduces bacterial attachment. International Journal of Impotence Research (2003) 15, Suppl 5, S150-S154. doi:10.1038/sj.ijir.3901093Keywords: biofilm; prosthetic infection; erectile function; penile prosthesis It is estimated that 10 million men in the United States are impotent. This is regarded as a conservative estimate by most, and as the population ages, this figure will undoubtedly increase. The last decade has seen enormous growth in our knowledge and understanding of erectile function leading to new approaches and directions in the therapy of erectile dysfunction. However, many individuals are unable to achieve erections by chemical enhancement, and they require the placement of a penile prosthesis to restore potency. It is estimated that more than 20 000 penile prosthesis operations are performed in the United States annually. 1 Penile implants are a well-established form of treatment for erectile dysfunction. However, penile implants are often regarded as a third-line treatment and the last resort after patients have failed oral and injection therapy. Yet, they have an extremely high rate of patient satisfaction. A large multicenter study published in 2000 reports a greater than 90% 5-y and greater than 70% 10-y device survival. 2 This study also revealed that 79% of men were still using their prosthesis at 5-y. Furthermore, 86% stated they would unde...

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Inflatable Penile Implant Infection: Predisposing Factors and Treatment Suggestions

Cited by 213 publications

References 13 publications

Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction?

Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction?

Eficácia e segurança da prótese peniana inflável no tratamento de disfunção erétil em pacientes diabéticos

Bacterial Biofilms and implantable prosthetic devices

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