North American Consensus Document on Infection of Penile Prostheses

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

“…Therefore, prevention of contamination by the surgical team, the patient, and the operating room environment are critical and are summarized in Table 1. In 2013, a Hofer & Gonzalez panel of experts defined clinical guidelines to decrease the rates of penile infections 28 and provided the basis for the following recommendations.…”

“…28 Care should be taken to infuse vancomycin with sufficient lead time before skin incision to allow for maximum blood concentration of this antibiotic (typically 1 hour). There has traditionally been a great variety in postoperative antibiotic management after prosthesis implantation, 30 and based on the expert opinion in the guideline, a 5-to 14-day course of oral antibiotics with trimethoprim-sulfamethoxazole (or doxycycline if the patient has a sulfa allergy) has been recommended.…”

“…There has traditionally been a great variety in postoperative antibiotic management after prosthesis implantation, 30 and based on the expert opinion in the guideline, a 5-to 14-day course of oral antibiotics with trimethoprim-sulfamethoxazole (or doxycycline if the patient has a sulfa allergy) has been recommended. 28 Patient preparation Katz and colleagues 31 have shown that optimized blood sugar control (hemoglobin A 1c <10%) and a negative result of preoperative urine culture can reduce the risk of PP infection. A randomized controlled trial has shown a decreased incidence of surgical site infections by Staphylococcus aureus among patients who are nasal carriers with preoperative showering with chlorhexidine soap and the application of nasal mupirocin.…”

“…32 This regimen may be beneficial for patients with poor skin conditions. 28 Preparation of the surgical site should include cleansing using a chlorhexidine-alcohol-based solution because it has been found to be superior over traditional povidone-iodine solutions in reducing bacterial skin flora and surgical site infections 33,34 while not increasing irritation of the genital skin or urethral meatus. 34 The chlorhexidine-alcohol-based solution should be allowed to dry for 3 minutes before incision.…”

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

“…Penile prosthetic surgery is not particularly invasive but, given the critical and specific nature of erectile function, must produce a result which the patient finds both aesthetically and functionally acceptable (1,2) One of the most common and feared complications is infection, considered the worst complication in prosthetic surgery (3) and difficult to eradicate with common antibiotic therapy (4,5).The formation of an avascular biofilm (6,7) surrounding the prosthesis can harbor bacteria and inhibit the action of antibiotics and macrophages that would otherwise eliminate them; this almost always requires the implant's removal (8) due to the risk of generalized systemic infection.…”