Is a Closed-Suction Drain Advantageous for Penile Implant Surgery? The Debate Continues

Kramer, Amihud; Goldmark, Ellen; Greenfield, Jason

doi:10.1111/j.1743-6109.2010.02088.x

Cited by 17 publications

(12 citation statements)

References 38 publications

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“…Despite studies from the orthopedic literature describing the benefits of antibiotic prophylaxis for only 24 hours following foreign body implantation, the postoperative course is often prolonged, possibly unnecessarily, as it was among urologists in this study (mean 7 days among SMS and non‐SMS urologists) [4]. The purpose of surgical antimicrobial prophylaxis is to modulate intraoperative contamination of the surgical wound to an extent that permits host defenses to prevent infection and excessive treatment may contribute to antibiotic resistance [4,14,30,31]. In the general surgical literature, postoperative antibiotic prophylaxis has been shown to provide benefit following mesh hernia repair with 50% decrease in infection rate in one meta‐analysis, while there has been no benefit in other meta‐analyses [32,33].…”

Section: Discussionmentioning

confidence: 88%

“…as an immediate salvage procedure for infected IPP with demonstrated success rate of 85% [20,21]. Further, the use of closed‐suction drainage was not assessed which could affect infection outcomes [30]. Finally, surgical approach (infrapubic vs. scrotal) was not assessed, although this was not identified to be a significant factor in a study of 360 patients receiving primary implants [41].…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

Wosnitzer

Greenfield

2011

The Journal of Sexual Medicine

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

Wosnitzer

Greenfield

2011

The Journal of Sexual Medicine

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“…The majority of postoperative hematomas are recognized in the first few days, and can be managed conservatively with scrotal elevation, ice packs, compressive dressings, and antibiotics [12]. In one large series, the rate of immediate postoperative hematoma following IPP insertion decreased to 0.9% when a combination of pressure dressing, CSD placement, and partial inflation of prosthesis was employed [9].…”

Section: Discussionmentioning

confidence: 99%

Delayed Postoperative Hematoma Formation After Inflatable Penile Prosthesis Implantation

Garber

Bickell

2015

The Journal of Sexual Medicine

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Introduction Infrequent but serious postoperative complications following inflatable penile prosthesis (IPP) insertion include infection, malfunction, and bleeding. Although prior publications report methods to reduce immediate postoperative bleeding, there is little in the literature concerning the etiology, diagnosis, imaging, and management of delayed bleeding after IPP insertion. Aim The aim of the study was to review cases of delayed postoperative bleeding following IPP insertion in a large single-surgeon series. Methods We carried out a retrospective chart review of 600 patients implanted with a Coloplast Titan IPP with One-Touch Release pump by a single surgeon, and analyzed cases of delayed postoperative bleeding. Main Outcome Measure The main outcome measure was an analysis of the incidence, causes, diagnostic methods, treatment, and final outcome of these cases. Results Three out of 600 consecutive patients (0.5%) developed a delayed (defined as >5 days postoperative) hematoma following IPP insertion. All patients presented postoperatively with a swollen surgical site, and all were evaluated with a pelvic computed tomography scan to completely define the extent of the hematoma. Two patients developed a delayed hematoma because of excessive physical activity; the remaining patient bled because of premature administration of enoxaparin sodium (Lovenox) by his cardiologist. All three patients were successfully treated with hospital admission, intravenous antibiotics, wound exploration, hematoma evacuation, and antibiotic washout. All three IPPs were successfully salvaged; none developed peri-prosthetic infection. Conclusions The incidence of delayed postoperative hematoma following IPP surgery was 0.5% in our series of 600 cases. All cases were successfully managed with intravenous antibiotics, hematoma evacuation, and antibiotic washout. Because of the low incidence of this complication, definitive statements concerning prevention and management cannot be made. However, we now recommend avoiding postoperative anticoagulants for at least 5 days if possible, and avoiding vigorous physical activity for at least 3 weeks.

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“…The correct antibiotic therapy able to eliminate or diminish the incidence of infections of penile prostheses continues to be researched and debated [20,21]. All patients were recommended to clean their genitals with iodopovidone fluid twice a day for the 3 days before surgery.…”

Section: Infectious Complicationsmentioning

confidence: 99%

Penile Prosthesis Surgery in Italy: Personal Experiences, Complications and Considerations after 552 Cases

Pozza¹,

Pozza²,

Pozza³

2018

Int Arch Urol Complic

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The Implant of Penile Prostheses (Silicone, Malleable, Inflatable) represents an efficient solution for patients affected by Erectile Dysfunction (ED) and penetrating incapacity who do not respond to the other treatment modalities (PDE5i, PGE1, Vacuum Systems). Patients with penile prostheses regain the spontaneity of intercourses without having to assume drugs, to introduce mechanically medical substances or to activate complex mechanisms. Just like the whole field of prosthetic surgery, introducing into the organism a "foreign body" can lead to complications connected to the patient, the inserted matter, the inserting surgical procedure and the after-care. A "relevant" complication-which almost always leads to the removal of the implant and thus to the failure of the surgeon's treatment and to the extreme disappointment of the patient's expectations-can often be considered as result of an initially "small" complication, which could be faced and solved (with drugs or a minor surgery) without having to resort to removal. The authors present a variety of medical and surgical procedures, derived from their over 34-year experience (1984-2018) in Penile Prosthesis Surgery (PPS), which may be implemented to avoid implant failure. Plenty of other complications are possible and have been registered in Medical Literature. They are often caused by reactions of the penile tissues, by vascular or hemorrhagic phenomena, by modifications in the penile or glans sensibility.

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Is a Closed-Suction Drain Advantageous for Penile Implant Surgery? The Debate Continues

Cited by 17 publications

References 38 publications

Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

Delayed Postoperative Hematoma Formation After Inflatable Penile Prosthesis Implantation

Penile Prosthesis Surgery in Italy: Personal Experiences, Complications and Considerations after 552 Cases

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