Anti-Infection Dip Suggestions for the Coloplast Titan Inflatable Penile Prosthesis in the Era of the Infection Retardant Coated Implant

Abstract

Introduction Infection is the worst complication seen with inflatable penile prosthesis (IPP). Both the American Medical Systems (AMS) and Coloplast IPP have infection retardant coatings. AMS is coated at the factory with rifampicin and minocycline (InhibiZone). The Coloplast IPP has a hydrophilic coating covalently bonded to its components that will absorb any aqueous solution before implantation and provides increased surface lubricity to decrease bacterial adherence. Aim We tested several antibiotic dips comparing zones of inhibition (ZOI) against five commonly infecting bacteria with coated Coloplast implants. Results were compared with those ZOI created with strips of an AMS IPP precoated with InhibiZone. Methods Pieces of sterile Coloplast Titan IPP were dipped in (i) trimethoprim/polymixin B ophthalmic solution; (ii) trimethoprim/sulfamethoxazole infusion solution; (iii) bacitracin; (iv) rifampicin/minocycline; and (v) rifampin/trimehtoprim/sulfamethoxazole. ZOI for the Titan strips and for AMS InhibiZone coated strips were tested against Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus aureus, Pseudomonas, and Enterococcus. Main Outcome Measure ZOIs of the Coloplast Titan for each of the medicated solutions were compared with ZOI created by undipped strips of a sterile InhibiZone coated IPP placed on plates of the identical bacteria. Results All dips except bacitracin showed ZOI ≥ InhibiZone (P ≥ 0.005) for most organisms. Because of broad-spectrum effectiveness, ease of handling, and cost, infusion vial of trimehtoprim/sulfamethoxazole seemed optimal at this time. If trimehtoprim/sulfamethoxazole is unavailable; the ZOI with Polytrim ophthalmic solution zones were almost as good. Conclusions The Coloplast strips when dipped in several solutions showed equal or significantly larger ZOI against commonly infecting organisms than the InhibiZone coated strips. At the present time using off the shelf trimethoprim sulfamethoxazole infusion solution seems optimum. The flexibility of choosing the drug eluting from the Coloplast device seems promising in the changing bacterial environment.

Long-Term Revision Rate Due to Infection in Hydrophilic-Coated Inflatable Penile Prostheses: 11-Year Follow-up

“…In a study by Wilson et al. the zones of inhibition against these specific bacteria using the hydrophilic‐coated Coloplast implant immersed in several antibiotic solutions and InhibiZone‐coated IPP strips demonstrated the Coloplast IPP strips (except the ones soaked in bacitracin) had greater zone of inhibition compared with InhibiZone‐impregnated IPPs [20]. The authors also suggested that trimethoprim sulfamethoxazole solution is to be the optimum solution to soak the hydrophilic‐coated IPPs.…”

Inflatable Penile Prosthesis and Salvage Protocol for Mechanical Failure: Is it Really Necessary?

“…In 2002, Mentor (now Coloplast) introduced the Titan coating, a hydrophilic substance that reduced bacterial adherence and absorbs and distributes the antibiotic coating that the surgeon chooses to use intraoperatively [10]. Several studies have shown the benefit of these antibiotic‐coated designs [13–15]. This is also likely a significant reason for the low infection rate in our study.…”

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

“…This variation has the advantage of tailoring the antibiotic to the surgeon's discretion and the site's susceptibility profile. In vitro studies have suggested that the hydrophilic coating may have an improved antibacterial effect over rifampin/minocycline coating, 23 yet both coatings seem to be equally effective clinically. A recent report by Serefoglu and colleagues 24 analyzed over 36,000 primary PPs with hydrophilic coating and found that the infection rate of coated devices decreased to 1.4% compared to 4.6% for uncoated models at 11 years follow-up.…”