Penile implant infection prevention part II: device coatings have changed the game

Background and Objective Since immediate salvage (IS) surgery for infected penile prosthesis (PP) was introduced nearly 30 years ago, an abundance of evidence has emerged in support of its use. IS remains underutilized by the modern urologist despite its distinct advantages. While some medical literature proposes reasons for the underuse of IS, no comprehensive review attempts to address the numerous factors limiting its implementation. Our objective is to analyze the barriers to IS surgery for infected PP with the goal of expanding utilization of this technique through a practical and standardized approach for treating urologists. Methods A narrative review of available English, peer-reviewed, medical literature relevant to the barriers to IS was completed. Searches were expanded to include literature from surgical specialties in general if hypothesized barriers were incompletely described in available PP publications. Key Content and Findings The major barriers that are likely contributing to the low rates of IS for PP surgery can be broadly classified into three major categories: institutional/systemic, medical/surgical, and patient preference. Institutional/systemically driven barriers include surgeon comfort with PP surgery, low national availability of urologists, inaccessibility of prosthetics or critical ancillary staff at the time of patient presentation and limited operating room (OR) access. Medical/surgical barriers primarily relate to reinfection fears, perceived contraindications to IS, and overall patient stability at the time of presentation. Patient preference factors inhibiting IS involve loss of trust in the medical team, psychosocial distress, dissatisfaction with the initial device prior to infection and anxiety regarding postoperative recovery. Many of the identified barriers can be overcome with increased surgical training, improved patient and surgeon understanding of PP infection, or precautionary planning. Conclusions Of the factors that contribute to low utilization of IS, many are misunderstood or unknown. Recognition of these barriers may equip urologists to provide better care to patients with prosthesis infection.

Section: Resultsmentioning

confidence: 99%

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Grimaud,

Barquin,

Kurnot

et al. 2024

“…While no standardized irrigation protocol exists, some authors have reported modified techniques of antiseptic washout during removal and replacement of infected prosthetic with high reinfection-free success rates (>80%) across various cohorts ( 11 , 12 , 14 ). What’s more, there have also been reported successes with salvage surgery without any antibiotic irrigation ( 48 ). This begs the question whether antibiotics are necessary during manual irrigation.…”

Section: Treatment Selection and Technique For Immediate Salvage Surgerymentioning

confidence: 99%

Narrative review of immediate salvage for penile prosthesis infection

Adams,

Tua-Caraccia,

Lentz

2024

Background and Objective Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. Methods We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: “inflatable penile prosthesis”, “IPP”, “penile prosthesis”, “salvage”, “treatment”, “delayed”, “immediate”. Only English peer-reviewed publications were included. Key Content and Findings Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Conclusions Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

“…Advances in PP designs with the use of infection-retardant coatings have also led to significant decreases in overall PP infection rates (40). Boston Scientific (Marlborough, MA) introduced the InhibiZone technology into the AMS 700 inflatable PP in 2001, which contains minocycline and rifampin (41).…”

Section: Current Applications To Reduce Biofilm Attachmentmentioning

confidence: 99%

A scoping review of penile implant biofilms—what do we know and what remains unknown?

Leong¹,

Capella²,

D'Amico³

et al. 2022

Background: PP is a gold standard for treatment of erectile dysfunction given its reliability and efficacy.Infection remains the most feared complication of prosthetic surgery, which usually results in device removal, and places a significant economic burden on the healthcare system. While biofilms have shown to support the persistence of microorganisms, the degree by which this matrix is truly pathogenic remains unknown given its high prevalence even in asymptomatic patients. We aim to review and summarize the current literature pertaining to biofilm formation in the setting of penile prosthesis (PP) surgeries in clinically infected and non-infected cases.Methods: Searches were performed in the MEDLINE online database through PubMed using a combination of keywords "penile prosthetic" OR "penile prosthesis" OR "penile implant" AND "biofilm" OR "revision" OR "removal" OR "infection" OR "explant". Eleven articles met inclusion criteria. There were only three studies that explicitly listed the number of biofilms identified in their cohort, but we also included eight articles that mentioned swabbing and culturing of any bacterial biofilm during revision procedures for both clinically infected and non-infected implants.Results: Infected PP yielded a 11-100% rate of biofilm presence, while non-infected PP yielded a 3-70% rate of biofilm presence. Time to reoperation from initial PP placement were also largely variable, ranging from 2 weeks to over 2 years. Coagulase-negative staphylococcus (i.e., Staphylococcus epidermidis) were the most commonly reported organisms among non-infected implants, however, newer studies have identified a change towards more virulent organisms.Conclusions: Since the advent of PP surgery, diabetes control, revision washout protocols and antibioticimpregnated devices have led to an overall decrease in biofilm formation and infectious complications.There is an overall paradigm shift in microbial profiles with more virulent organisms, such as Escherichia coli, Pseudomonas aeruginosa, Enterococcus species, and even fungal species beginning to replace the more common coagulase-negative staphylococcal species, especially in clinically infected implants. Additional studies are necessary to define the significance of bacterial presence in biofilms using impactful technologies such as next-generation sequencing. Currently, preliminary and experimental biofilm-control strategies are also underway to further address this clinical issue.