ABSTRACT
INTRODUCTION: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. AIM: To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. METHODS: This retrospective institutional review board-exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. MAIN OUTCOME MEASURES: Intraoperative culture data from infected IPPs. RESULTS: Two hundred twenty-seven intraoperative cultures (2002-2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. CONCLUSION: This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455-463.
Subject(s)
Antibiotic Prophylaxis , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/prevention & control , Anti-Bacterial Agents/therapeutic use , Humans , Male , Methicillin-Resistant Staphylococcus aureus , Penile Prosthesis/adverse effects , Reoperation/adverse effects , Retrospective StudiesABSTRACT
OBJECTIVES: The aim is to assess our experience with new Coloplast Titan™ Inflatable Penile Prosthesis (IPP) with One-Touch Release (OTR) pump. Our 3 main focuses of attention will be prosthesis performance and patient and partner satisfaction in our first 100 cases in 3 specialised centres by 2 principal surgeons. METHODS: Retrospective review was used to assess the Coloplast Titan™ OTR implant procedures/cases in our departments (from October 2009 to December 2012). The changes in Erection Function (EF), Intercourse Satisfaction (IS), overall satisfaction of the patient and partner were assessed by use of the following questionnaires: EF and IS domains of the International Index of Erectile Function (IIEF) and modified EDITS. RESULTS: Mean patient age (N = 100) was 54.2 years old (range: 20-77) with a mean length of follow-up of 21 months (range: 6-44). Mean length of prosthesis implanted was 18.6 cm (14-23.5). Only 3% of patients showed complications requiring surgical exploration. Good prosthesis performance was assessed in 99 patients (99%). Differences in the IIEF-EF and IIEF-IS domain before and after surgery were +16.8 and +6.4 respectively. Patient and partner overall satisfaction were 90% and 84% respectively in modified EDITS. The average number of postoperative teaching sessions needed to teach the patient how to operate the device was 1.28 (1-4). CONCLUSIONS: The Coloplast Titan™ OTR IPP was easy to implant, inflate, and deflate with high levels of EF improvement, patient and partner satisfaction. A small number of postoperative teaching sessions were required for the patient to properly operate the device.
Subject(s)
Penile Prosthesis , Adult , Aged , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Scrotum , Young AdultABSTRACT
OBJETIVOS: Presentar nuestra experiencia con la prótesis de pene Coloplast Titan™ One-Touch Release. Evaluamos el correcto funcionamiento de la prótesis, facilidad de manejo, grado de satisfacción del paciente y de su pareja en los primeros 100 casos realizados en tres centros implantadores. MÉTODOS: Revisión retrospectiva de los 100 primeros pacientes tratados mediante la colocación de la prótesis de pene Coloplast Titan™ One-Touch Release (Octubre 2009 a Diciembre 2012). La función eréctil y la satisfacción por parte del paciente y su pareja se evaluaron mediante los cuestionarios: The International Index of Erectile Function (IIEF), Intercourse Satisfaction (IS) y EDITS modificado pre y postoperatorio. La facilidad de manejo fue evaluada en función del número de consultas de aprendizaje. RESULTADOS: La edad media de los pacientes (N:100) fue de 54.2 años (20-77). El seguimiento medio (N = 100) fue de 21 meses (6-44). La longitud media de las prótesis implantadas fue de 18.6 cm (14-23.5). Tan sólo un 3% de pacientes presentaron complicaciones que requirieron exploración quirúrgica. El buen funcionamiento de la prótesis fue confirmado en 99 pacientes (99%). Las diferencias en los valores de IIEF-EF y IIEF-IS pre y postoperatorios fueron +16.8 y +6.4 respectivamente (p < 0.05). El cuestionario EDITS modificado mostraba una satisfacción global del 90% de los pacientes y del 84% de las parejas. El número medio de consultas de aprendizaje fue de 1.28 (1-4). CONCLUSIONES: El modelo de prótesis de pene Coloplast Titan™ One-Touch Release es sencilla de implantar y manejar, con una importante mejora de la función eréctil y la satisfacción del paciente y su pareja
OBJECTIVES: The aim is to assess our experience with new Coloplast Titan™ Inflatable Penile Prosthesis (IPP) with One-Touch Release (OTR) pump. Our 3 main focuses of attention will be prosthesis performance and patient and partner satisfaction in our first 100 cases in 3 specialised centres by 2 principal surgeons. METHODS: Retrospective review was used to assess the Coloplast Titan™ OTR implant procedures/cases in our departments (from October 2009 to December 2012). The changes in Erection Function (EF), Intercourse Satisfaction (IS), overall satisfaction of the patient and partner were assessed by use of the following questionnaires: EF and IS domains of the International Index of Erectile Function (IIEF) and modified EDITS. RESULTS: Mean patient age (N = 100) was 54.2 years old (range: 20-77) with a mean length of follow-up of 21 months (range: 6-44). Mean length of prosthesis implanted was 18.6 cm (14-23.5). Only 3% of patients showed complications requiring surgical exploration. Good prosthesis performance was assessed in 99 patients (99%). Differences in the IIEF-EF and IIEF-IS domain before and after surgery were +16.8 and +6.4 respectively. Patient and partner overall satisfaction were 90% and 84% respectively in modified EDITS. The average number of postoperative teaching sessions needed to teach the patient how to operate the device was 1.28 (1-4). CONCLUSIONS: The Coloplast Titan™ OTR IPP was easy to implant, inflate, and deflate with high levels of EF improvement, patient and partner satisfaction. A small number of postoperative teaching sessions were required for the patient to properly operate the device
