Penile Prosthesis Infection: Myths and Realities

Hebert, Kevin; Köhler, Tobias

doi:10.5534/wjmh.180123

Cited by 59 publications

(30 citation statements)

References 79 publications

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“…in cases of urethral atrophy). Similar findings have been seen in the inflatable penile prosthesis literature as there is level II evidence that revision surgery increases the risk of infection [ 12 ]. However, the etiology of device failure in the revision AUS surgery population is likely a “multiple-hit” phenomenon related to a combination of prior tissue manipulation in addition to one or more comorbidities which impair small vessel function (diabetes, coronary artery disease, smoking status, and prior radiotherapy).…”

Section: Discussionsupporting

confidence: 82%

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

Hebert

Linder

Morrisson

et al. 2021

Asian Journal of Urology

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Objective The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. Methods We identified 2045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN, USA) from 1983 to 2013. Of these, 1079 were primary AUS implantations and 281 were initial revision surgeries, which comprised our study group. Device survival rates, including overall and specific rates for device infection/erosion, urethral atrophy and mechanical failure, were compared between primary AUS placements versus revision surgeries. Patient follow-up was obtained through office examination, written correspondence, or telephone correspondence. Results During the study period, 1079 (79.3%) patients had a primary AUS placement and 281 (20.7%) patients underwent a first revision surgery for mechanical failure or urethral atrophy. Patients undergoing revision surgery were found to have adverse 1- and 5-year AUS device survival on Kaplan–Meier analysis, 90% vs. 85% and 74% vs. 61%, respectively ( p <0.001). Specifically, revision surgery was associated with a significantly increased cumulative incidence of explantation for device infection/urethral erosion (4.2% vs. 7.5% at 1 year; p =0.02), with similar rates of repeat surgery for mechanical failure ( p =0.43) and urethral atrophy ( p =0.77). Conclusions Our findings suggest a significantly higher rate of overall device failure following revision AUS surgery, which is likely secondary to an increased rate of infection/urethral erosion events.

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Section: Discussionsupporting

confidence: 82%

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

Hebert

Linder

Morrisson

et al. 2021

Asian Journal of Urology

Self Cite

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“…However, use of a razor for hair removal compared to use of clippers was associated with an increase in postoperative infection (relative risk = 2.09, 95% confidence interval = 1.15–3.80). It is also important to notice that, although the 2016 ICSM guidelines recommend the use of an alcohol-based skin prep prior to IPP placement [16], the studies we found are discordant and did not show the superiority of a disinfectant on the others [17, 18]. Further research is needed into the standardization of pre-, peri-, and postoperative measures: guidance on these measures needs to be clear to both surgeons and patients.…”

Section: Resultsmentioning

confidence: 89%

“…It is commonly believed that some trivial measures like adequate hygiene, local application of ice, and the use of suspensory or wrap-around underwear may help to reduce the risk of PPI. A recent review by Hebert and Kohler [16] examined multiple preoperative/intraoperative factors evaluating their influence on the risk of PPI and divided them into elements that increase the risk, elements that reduce the risk, and elements that do not influence the risk. They used the 2011 Oxford Center for Evidence-Based Medicine Guidelines to give each conclusion a level of evidence (from Level 1 that means strongest evidence to Level 5 that represents weaker evidence).…”

Section: Resultsmentioning

confidence: 99%

Treatment of Penile Prosthesis Implant’s Infection

Cosentino¹,

Bianco

Ruíz-Castañé

et al. 2020

Urol Int

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Introduction: Penile prosthesis implant is a safe and effective option in erectile dysfunction patients, being implant procedures safe with a low risk of infection. However, when infection occurs, it represents a concrete problem for both surgeon and patient. Methods: This is a comprehensive review of all issues relating to prosthesis infection, including causes and risk factors, methods of prevention, and management. We analyzed all preoperative and perioperative factors, which can play a role in infection of the device. Results: Infection of penile prosthesis implant is hard to manage and correct. While the incidence of infection following first implant is up to 3%, in cases of re-implant surgery, the rate can reach as high as 18%. Many articles were found addressing prevention and treatment of penile prosthesis infection, and many analyzed all relevant pre-and perioperative factors associated with penile prosthesis implant. Although such factors have been well studied, there is no clear consensus worldwide on certain topics. Conclusions: Penile prosthesis implant is a safe and effective option. Despite infection is a rare event, surgeons should follow strictly pre-, intra-and postoperative recommendations in order to reduce the risk of device's infection. An appropriate antibiotic therapy should be tailored on patient's characteristics and pathogens isolated.

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“…Despite these improvements, the possibility that the insertion of a prosthesis could lead to dangerous and harmful maneuvers still exists. We have to consider that the particular weakness of the cavernous and perineal tissues such as may occur after pelvic surgery or radiation therapy, the structural alterations in Peyronie's Disease (PD) and the presence of comorbidity such as Diabetes Mellitus (DM) or Coronary Artery Disease (CAD) continue to make Penile Prosthetic Surgery (PPS) a risky surgery (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Penile prosthesis and complications: Results from 577 implants

Pozza¹,

Marcantonio²,

Mosca³

et al. 2020

Arch Ital Urol Androl

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Objective: Penile Prosthetic Surgery is already well characterized but the problems connected with possible complications still need to be evaluated and discussed. Material and Methods: The Authors revaluated their experience in Penile Prosthetic Surgery involving 577 patients (18 - 86 years, mean age 51.3 years) operated by the same surgeon since 1984. We implanted 199 silicone-semi-rigid (Small Carrion, Implantal, Eurogest, Subrini, SSDA GS), 200 malleable (Jonas, Omniphase, Duraphase, AMS600, MentorColoplast Genesis, Vedise) and 178 inflatable (Mentor: Mark II, Alpha I, Titan OTR; AMS: mono-component Hydroflex, Dynaflex; bi-component Ambicor; multicomponent: 700 Ultrex, 700 CX, 700 LGX) prostheses. Operative, postoperative, infectious and malfunctioning complications have been recorded. A total of 156 patients drop out at follow-up and we may not exclude possible late complications treated at different hospitals. Results: The recorded complications and the therapeutic modalities utilized to treat them are examined. Operative complications were recorded in 2 malleable prostheses (MPP) and in one inflatable prosthesis (IPP). Postoperative complications have been recorded in three cases of MPP (1.5%) and in 9 IPP (5.0%) and were strictly connected to general medical co-morbidities as diabetes mellitus (DM), coronary artery dysfunction (CAD), and Peyronie’s disease (PD). In three cases of IPP implantation, hematomas were related to the blunt surgical maneuvers utilized to insert the reservoir or the scrotal pumps. Infectious complications were mostly observed in patients with DM: 4 patients with MPP (1.0%) and 15 patients with IPP (8.4%). Malfunction rate of the prostheses in our series was really disappointing considering that 13/17 cases (77%) of mono-component IPP broke while in patients with multicomponent IPP the percentage of malfunction has been of 13/161 (8%) and malfunction was observed in only one case of MPP. We were forced to explant the prostheses in 2 patients with MPP (0.5%) and 40 with IPP (22%). However, after excluding 17 mono-component IPPs, the percentage of explants of multicomponent IPP (23 patients, 4.2%) is in line with other significative experiences. Conclusion: The number of complications of PPS are similar to those reported by well qualified urological institutions. In our experience a scrupulous antibiotic therapeutic schedule, avoiding direct contact between the prostheses and the patient’s skin, reduced time of surgery with surgeon’s experience positively influenced the results.In a limited number of patients medical treatment or minimal surgical acts allowed to solve the complications preserving the prostheses and avoiding the prosthetic explant

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Penile Prosthesis Infection: Myths and Realities

Cited by 59 publications

References 79 publications

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

Treatment of Penile Prosthesis Implant’s Infection

Penile prosthesis and complications: Results from 577 implants

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