Minimising the risk of device infection in penile prosthetic surgery: a UK perspective

Abstract

We have reviewed articles published on penile prosthetic infection in Medline and EMBASE databases from 2000 to 2012 with the intention of signposting ‘best evidence’ for the UK prosthetic implanter. Using the Oxford Centre for Evidence-based Medicine Levels of Evidence (LE), no paper exceeded an LE of 2b and the majority were LE 4 (case series) and LE 5 (expert opinion). This is not surprising from a UK perspective since HES data for 2009 to 2010 reported 263 penile prosthetic surgeries performed in 35 hospitals, with only five hospitals performing 15 or more. Our literature review suggests that the use of antibiotic-coated IPPs and measures aimed at reducing inoculating bacteria into the surgical wound with alcohol skin preparation, a no-touch technique and peri-operative antibiotic use are most important in minimising the risk of device infection. The use of post-operative antibiotics is contentious (LE 5). It remains unproven whether diabetics have a higher rate of prosthetic infection compared to nondiabetics. In cases of re-implantation for mechanical failure, it remains debatable whether a washout technique should be used and indeed uncertainty remains regarding the pathological role of biofilm in the causation of device infection in this scenario. A washout technique during salvage penile prosthetic surgery for device infection is advocated. Further research on biofilm may offer the best chance of reducing the incidence of device infections overall.

Comparing Risk Factors for Adverse Outcomes in Virgin Inflatable Penile Prosthesis Implantations and Revisions: A Retrospective Cohort Study

“…Recent studies have found the rate of postoperative infection following IPP implantation to be between 0.5% and 3%. 6 , 7 , 8 , 9 , 10 , 11 , 12 However, many of these recent studies exclude at-risk demographics, such as those with a history of prior IPP implantation, 3 , 6 , 7 , 9 , 20 IPP infection, 5 , 10 , 11 , 14 and successive revisions. 5 , 8 After including these at-risk demographics, our study determined the rate of postoperative infection to be 8.20%, a rate higher than that quoted in recent studies.…”

“…Prior studies have provided varied evidence regarding the rate of postoperative complications for those undergoing IPP revision. While all but 1 study reviewed 16 revealed that those undergoing revision experienced greater rates of complications, 5 , 8 , 12 the reported complication rates for these patients have varied. While some studies quote the infection rate for these patients to be as high as 10–18%, 5 , 8 , 12 , 14 other studies report that, with proper device washout and the use of other infection limiting techniques, 16 this rate may be as low as 3–4%.…”

“…4 However, more recent studies have not found a statistically significant relationship between DM and adverse surgical outcomes. 5,12,19 Concerning patients undergoing IPP revisions, studies have shown that the rate of infection in this group is 2e3 times greater, 5,8 and up to 10 times greater, 12 than that following virgin implantations.…”

“…While historically, the infection rate following virgin IPP placements was reported at 10%, 4 , 5 recent studies place this estimate closer to 0.5–3%. 6 , 7 , 8 , 9 , 10 , 11 , 12 Much of the success in lowering the rate of postoperative infection is likely due to a combination of the use of antibiotic-coated prostheses, 7 , 8 , 9 , 10 , 11 , 12 , 13 “no touch” surgical technique, 10 the Mulcahy salvage protocol, 14 , 15 , 16 and alcohol-based skin prep regimens. 17 , 18 In addition, this reduction is likely due in part to the identification of at-risk demographics.…”

“…Studies examining these demographics have identified those with diabetes mellitus (DM) and undergoing IPP revision to be at a higher risk of infection. 4 , 5 , 7 , 8 , 12 These risk factors remain somewhat controversial as multiple studies disagree regarding the true effect of each risk factor. Regarding the most examined potential risk factor, some studies showed the risk of postoperative infection for those with DM to range up to 18%.…”