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REVISION WASHOUT DECREASES PENILE PROSTHESIS INFECTION IN REVISION SURGERY: A MULTICENTER STUDY

2005; Lippincott Williams & Wilkins; Volume: 173; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000146717.62215.6f

1527-3792

Gerard D. Henry, Steven K. Wilson, John R. Delk, Culley C. Carson, Jeremy Wiygul, Chris Tornehl, Mario A. Cleves, Ari D. Silverstein, Craig F. Donatucci,

Kidney Stones and Urolithiasis Treatments

No AccessJournal of UrologyAdult Urology: Infection/Inflammation1 Jan 2005REVISION WASHOUT DECREASES PENILE PROSTHESIS INFECTION IN REVISION SURGERY: A MULTICENTER STUDY GERARD D. HENRY, STEVEN K. WILSON, JOHN R. DELK, CULLEY C. CARSON, JEREMY WIYGUL, CHRIS TORNEHL, MARIO A. CLEVES, ARI SILVERSTEIN, and CRAIG F. DONATUCCI GERARD D. HENRYGERARD D. HENRY , STEVEN K. WILSONSTEVEN K. WILSON , JOHN R. DELKJOHN R. DELK , CULLEY C. CARSONCULLEY C. CARSON , JEREMY WIYGULJEREMY WIYGUL , CHRIS TORNEHLCHRIS TORNEHL , MARIO A. CLEVESMARIO A. CLEVES , ARI SILVERSTEINARI SILVERSTEIN , and CRAIG F. DONATUCCICRAIG F. DONATUCCI View All Author Informationhttps://doi.org/10.1097/01.ju.0000146717.62215.6fAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Reoperation of penile implants carries a higher risk of infection (7% to 18%). Positive cultures and visible bacterial biofilm have been shown to be present on clinically uninfected inflatable penile prostheses (IPPs) at revision. A salvage irrigation protocol has proved to rescue patients with a clinically infected IPP. During revision surgery for noninfectious reasons we investigated washing out the implant space at revision surgery and using an antibiotic coated replacement prosthesis to determine if it would decrease subsequent infection rates. Materials and Methods: At 3 institutions 183 patients with a penile prosthesis underwent revision surgery for noninfectious reasons between June 2001 and October 2003. Of these patients 140 had the entire implant removed and then underwent antiseptic solution lavage of the implant spaces (revision washout), followed by replacement with a 3 piece IPP. This revision washout is a modification of the original Mulcahy salvage procedure. In the remaining 43 patients the implant was removed but they did not undergo antiseptic irrigation before replacement with an antibiotic coated IPP. Patients were followed for 6 to 33 months, while observing for failure. Results: Four of the 140 patients (2.86%) who underwent removal of the entire implant with irrigation of the implant spaces with antiseptic solutions and replacement with an IPP have had infection. In the remaining group 5 of the 43 patients (11.6%) who did not undergo antiseptic irrigation had infection. The difference was statistically significant at the 5% level (Fisher's exact test p = 0.034). Conclusions: Early results of combining complete implant removal and modified salvage protocol indicate a markedly decreased incidence of infection in patients with a penile prosthesis undergoing revision for noninfectious reasons. References 1 : The AMS700 inflatable penile prosthesis: long-term experience with the controlled expansion cylinders. J Urol1993; 149: 46. 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Google Scholar From Regional Urology (GDH), Shreveport, Louisiana, Institute for Urologic Excellence (SKW, JRD), Van Buren and Department of Biostatistics, University of Arkansas for Medical Sciences (MAC), Little Rock, Arkansas, Department of Urology, University of North Carolina (CCC, CT), Chapel Hill and Division of Urology, Department of Surgery, Duke University (JW, AS, CFD), Durham, North Carolina© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byZiegelmann M, Linder B, Avant R and Elliott D (2019) Bacterial Cultures at the Time of Artificial Urinary Sphincter Revision Surgery in Clinically Uninfected Devices: A Contemporary SeriesJournal of Urology, VOL. 201, NO. 6, (1152-1157), Online publication date: 1-Jun-2019.Hecht S and Hedges J (2015) Management of the Infected Penile ProsthesisJournal of Urology, VOL. 195, NO. 3, (546-547), Online publication date: 1-Mar-2016.Saitz T, Serefoglu E and Hellstrom W (2012) Re: Long-Term Infection Outcomes of 3-Piece Antibiotic Impregnated Penile Prostheses Used in Replacement Implant SurgeryJournal of Urology, VOL. 189, NO. 5, (1994-1996), Online publication date: 1-May-2013.Muench P (2012) Infections Versus Penile Implants: The War on BugsJournal of Urology, VOL. 189, NO. 5, (1631-1637), Online publication date: 1-May-2013.Yeung L, Grewal S, Bullock A, Lai H and Brandes S (2012) A Comparison of Chlorhexidine-Alcohol Versus Povidone-Iodine for Eliminating Skin Flora Before Genitourinary Prosthetic Surgery: A Randomized Controlled TrialJournal of Urology, VOL. 189, NO. 1, (136-140), Online publication date: 1-Jan-2013.Nehra A (2012) RE: Long-Term Infection Outcomes of 3-Piece Antibiotic Impregnated Penile Prostheses Used in Replacement Implant Surgery [Letter to the Editor JU-12-1703]Journal of Urology, Nehra A, Carson C, Chapin A and Ginkel A (2012) Long-Term Infection Outcomes of 3-Piece Antibiotic Impregnated Penile Prostheses Used in Replacement Implant SurgeryJournal of Urology, VOL. 188, NO. 3, (899-903), Online publication date: 1-Sep-2012.Carson C, Mulcahy J and Harsch M (2010) Long-Term Infection Outcomes After Original Antibiotic Impregnated Inflatable Penile Prosthesis Implants: Up to 7.7 Years of FollowupJournal of Urology, VOL. 185, NO. 2, (614-618), Online publication date: 1-Feb-2011.Henry G, Carson C, Wilson S, Wiygul J, Tornehl C, Cleves M, Simmons C and Donatucci C (2007) Revision Washout Decreases Implant Capsule Tissue Culture Positivity: A Multicenter StudyJournal of Urology, VOL. 179, NO. 1, (186-190), Online publication date: 1-Jan-2008.Abouassaly R, Angermeier K and Montague D (2018) Risk of Infection With an Antibiotic Coated Penile Prosthesis at Device Replacement for Mechanical FailureJournal of Urology, VOL. 176, NO. 6, (2471-2473), Online publication date: 1-Dec-2006.Silverstein A, Henry G, Evans B, Pasmore M, Simmons C and Donatucci C (2018) Biofilm Formation on Clinically Noninfected Penile ProsthesesJournal of Urology, VOL. 176, NO. 3, (1008-1011), Online publication date: 1-Sep-2006. Volume 173Issue 1January 2005Page: 89-92 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsinfectionbacteriapenisprostheses and implantsimpotenceMetricsAuthor Information GERARD D. HENRY Financial interest and/or other relationship with Medtronic, Lilly, Pfizer, American Medical Systems, Mentor, Bayer and Ortho-McNeil More articles by this author STEVEN K. WILSON More articles by this author JOHN R. DELK Financial interest and/or other relationship with American Medical Systems, Lilly-ICOS, Alza, Mexmed, Mentor, Bayer and Ortho-McNeil More articles by this author CULLEY C. CARSON Financial interest and/or other relationship with Lilly, Bayer and Pfizer More articles by this author JEREMY WIYGUL More articles by this author CHRIS TORNEHL More articles by this author MARIO A. CLEVES More articles by this author ARI SILVERSTEIN More articles by this author CRAIG F. 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