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Ancha N, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, Charles Osterberg E. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian J Androl 2024; 26:335-343. [PMID: 38376174 PMCID: PMC11280207 DOI: 10.4103/aja202386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
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Affiliation(s)
- Nirupama Ancha
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Maya Eldin
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Tarah Woodle
- Department of Urology, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Sofia Gereta
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Krishna Hariprasad
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Imani Butler
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - E Charles Osterberg
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
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Wilson SK, Gross MS. Celebrating 50 years of penile implants. Int J Impot Res 2023; 35:596-600. [PMID: 36650316 PMCID: PMC10622314 DOI: 10.1038/s41443-023-00663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Steven K Wilson
- Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Tua-Caraccia RD, Adams ES, Watters CR, Lentz AC. Management of urologic prosthetic reservoirs at the time of inguinal or pelvic surgery. Sex Med Rev 2023; 11:431-440. [PMID: 37200135 DOI: 10.1093/sxmrev/qead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic regions. Because of this, patients with urologic prosthetics sometimes present challenges during future nonprosthetic operations. Presently, there is no established guideline for device management with ensuing inguinal or pelvic surgery. AIMS This article outlines concerns during pelvic and inguinal surgery for patients with an artificial urinary sphincter and/or inflatable penile prosthesis and proposes an algorithm for preoperative surgical planning and decision making. METHODS We conducted a narrative review of the literature on operative management of these prosthetic devices. Publications were identified by searching electronic databases. Only peer-reviewed publications available in English were considered for this review. RESULTS We review the important considerations as well as available options for operative management of these prosthetic devices during subsequent nonprosthetic surgery and highlight the advantages and disadvantages of each. Finally, we suggest a framework for helping surgeons determine which management strategy is most appropriate for their individual patients. CONCLUSION The best management strategy will differ depending on patient values, the planned surgery, and patient-specific factors. Surgeons should understand and counsel patients on all available options and encourage informed, shared decision making to determine the best individualized approach.
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Affiliation(s)
- Rafael D Tua-Caraccia
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Eric S Adams
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Christopher R Watters
- Section of General and Minimally Invasive Surgery, Division of Surgical Oncology, Department of Surgery, Duke General Surgery of Raleigh, Raleigh, NC 27609, United States
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
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Baird BA, Parikh K, Broderick G. Penile implant infection factors: a contemporary narrative review of literature. Transl Androl Urol 2021; 10:3873-3884. [PMID: 34804829 PMCID: PMC8575569 DOI: 10.21037/tau-21-568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants. Background Types of penile prostheses (PP) include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection. Methods Searches were performed using MEDLINE and PubMed databases using keywords and phrases ‘penile implant AND infection’; ‘penile prosthesis AND infection’; ‘penile implant infection’. We have presented results from our literature search. We divided these into ‘Surgical Elements’ and ‘Patient Selection and Factors.’ Each topic is discussed in its own section. Conclusions Strides have been made since the initial penile prosthesis (IPP) surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of PP infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with PP.
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Cayetano-Alcaraz AA, Yassin M, Desai A, Tharakan T, Tsampoukas G, Zurli M, Minhas S. Penile implant surgery-managing complications. Fac Rev 2021; 10:73. [PMID: 34632459 PMCID: PMC8483239 DOI: 10.12703/r/10-73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
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Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
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Brimley SC, Yousif A, Kim J, Hellstrom WJG. Tips and tricks in the management of inflatable penile prosthesis infection: A review. Arab J Urol 2021; 19:346-352. [PMID: 34552785 PMCID: PMC8451622 DOI: 10.1080/2090598x.2021.1946335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: To review the management of inflatable penile prosthesis (IPP) infection. Methods: The ‘gold-standard’ treatment for medication-refractory erectile dysfunction is the IPP, wherein the most dreaded complication is infection. To prevent and manage an infected IPP requires a strict protocol during the pre-, intra-, and postoperative course. A variety of techniques and antibiotics are used in conjunction with IPP implantation to prevent contamination. This modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review of the literature examines the current practices by leading urologists in the management of IPP infection, as well as provides insights for improved patient outcomes. Results : Patient selection is important to reduce IPP infections, and those with risk factors need to be optimised prior to surgery. Proper antibiotic prophylaxis includes pre-, intra-, and postoperative administration. As most infections derive from normal skin flora, every measure must be taken to sterilise the skin and avoid direct device skin contact. Up to 3% of virgin IPPs develop infections and this number increases to 18% in revision cases. Antibiotic coverage depends on the presenting microbe, which can vary significantly between patients. Conclusions : A greater success in IPP implantation can be attributed to appropriate prophylaxis, field sterilisation, and surgical technique. For those implants that do become infected, often erectile function can be preserved by immediate antibiotic coverage combined with salvage procedures.
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Affiliation(s)
- Scott C Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Ayad Yousif
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Joseph Kim
- Department of Urology, Tulane University, New Orleans, LA, USA
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Khor NWM, Dhar A, Cameron-Strange A. The perils of penile enhancement: case report of a fulminant penile infection. BMC Urol 2021; 21:115. [PMID: 34429077 PMCID: PMC8386090 DOI: 10.1186/s12894-021-00878-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support. CASE PRESENTATION A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission. CONCLUSION This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.
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Affiliation(s)
- Nicole Wen Mun Khor
- Murnaghan Urology Department, Prince of Wales Hospital, Sydney, Australia.
- Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia.
| | - Ankur Dhar
- Murnaghan Urology Department, Prince of Wales Hospital, Sydney, Australia
| | - Alistair Cameron-Strange
- Murnaghan Urology Department, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia
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Talib R, Alnadhari I, Canguven O, Yassin A, Shamsodini A, Alrumaihi K, Al-Ansari A. HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction. Andrologia 2021; 53:e14132. [PMID: 34062008 DOI: 10.1111/and.14132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022] Open
Abstract
Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69 ± 31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58 ± 1.45 mmol/l (range: 4.1-12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p = 0.491). Limitations include retrospective single-centre design and low-infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed.
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Affiliation(s)
- Raidh Talib
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar
| | - Ibrahim Alnadhari
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar
| | - Onder Canguven
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar
| | - Aksam Yassin
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Ahmad Shamsodini
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar
| | - Khalid Alrumaihi
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Abdulla Al-Ansari
- Department of Urology, Andrology Unit, Hamad medical corporation, Doha, Qatar.,Weill Cornel Medical School (WCM-Q), Doha, Qatar
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A Systematic Review of Literature Regarding Whether Immediate Preoperative Hemoglobin A1c or Serum Glucose Are Risk Factors for Infection Following Penile Prosthesis Implantation. Urology 2021; 152:15-24. [DOI: 10.1016/j.urology.2021.01.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 01/18/2023]
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Al-Shaiji TF, Yaiesh SM, Al-Terki AE, Alhajeri FM. Infected penile prosthesis: literature review highlighting the status quo of prevention and management. Aging Male 2020; 23:447-456. [PMID: 30317910 DOI: 10.1080/13685538.2018.1519786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management. METHODS We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment. RESULTS Acute infection can present early with pain and discharge and detection of early signs is of utmost importance. MRI studies are more sensitive than CT studies to diagnose and plan surgical intervention. Introduction of antibiotic impregnated devices attributed to the reduction of infection rates with superiority proven for certain types; the no-touch technique had further reduced this rate. The Mulcahy salvage remains the most widely used surgical approach for treatment despite modifications and novel techniques described; conservative management of PP infections is recently reported with promising results. CONCLUSIONS Despite absence of strict guidelines for the management of infected PPs, we reviewed and discussed numerous panel opinions and suggestions throughout literature. More research into the pathology, prevention, conservative management and advances in surgical treatment of this condition are called for to produce guidelines that unite the efforts to tackle these infections.
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Affiliation(s)
- Tariq F Al-Shaiji
- Urology Unit, Department of Surgery, Amiri Hospital, Kuwait City, Kuwait
| | - Said M Yaiesh
- Kuwait Urology Board, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait
| | | | - Faisal M Alhajeri
- Urology Unit, Department of Surgery, Farwaniya Hospital, Kuwait City, Kuwait
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Abstract
Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these prostheses is infections, which ultimately require device explanation and placement of a new device. Over the past several decades, significant work has been done to reduce infection rates and optimize treatment strategies to reduce patient morbidity. This article reviews the current state of knowledge surrounding penile prosthesis infections, with attention to the evidence for methods to prevent infection and best practices for device reimplantation.
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Affiliation(s)
- Amanda R Swanton
- Department of Surgery, Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | | | - Martin S Gross
- Department of Surgery, Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
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12
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Huynh LM, Osman MM, Yafi FA. Risk profiling in patients undergoing penile prosthesis implantation. Asian J Androl 2020; 22:8-14. [PMID: 31489849 PMCID: PMC6958986 DOI: 10.4103/aja.aja_92_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.
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Affiliation(s)
- Linda M Huynh
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Mohamad M Osman
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
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Cosentino M, Bianco M, Ruiz-Castañé E, Iafrate M. Treatment of Penile Prosthesis Implant's Infection. Urol Int 2020; 104:542-545. [PMID: 32541156 DOI: 10.1159/000508472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penile prosthesis implant is a safe and effective option in erectile dysfunction patients, being implant procedures safe with a low risk of infection. However, when infection occurs, it represents a concrete problem for both surgeon and patient. METHODS This is a comprehensive review of all issues relating to prosthesis infection, including causes and risk factors, methods of prevention, and management. We analyzed all preoperative and perioperative factors, which can play a role in infection of the device. RESULTS Infection of penile prosthesis implant is hard to manage and correct. While the incidence of infection following first implant is up to 3%, in cases of re-implant surgery, the rate can reach as high as 18%. Many articles were found addressing prevention and treatment of penile prosthesis infection, and many analyzed all relevant pre- and perioperative factors associated with penile prosthesis implant. Although such factors have been well studied, there is no clear consensus worldwide on certain topics. CONCLUSIONS Penile prosthesis implant is a safe and effective option. Despite infection is a rare event, surgeons should follow strictly pre-, intra- and postoperative recommendations in order to reduce the risk of device's infection. An appropriate antibiotic therapy should be tailored on patient's characteristics and pathogens isolated.
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Affiliation(s)
- Marco Cosentino
- Head of Andrology and Urology Department, Casa di Cura Villa Maria, Padova, Italy,
| | - Marta Bianco
- Department of Surgical, Oncological and Gastroenterological Sciences, Urology Clinic, University of Padua, Padua, Italy
| | - Eduard Ruiz-Castañé
- Head of Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Massimo Iafrate
- Department of Surgical, Oncological and Gastroenterological Sciences, Urology Clinic, University of Padua, Padua, Italy
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15
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Carvajal A, Benavides J, García-Perdomo HA, Henry GD. Risk factors associated with penile prosthesis infection: systematic review and meta-analysis. Int J Impot Res 2020; 32:587-597. [PMID: 32015525 DOI: 10.1038/s41443-020-0232-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/28/2019] [Accepted: 01/17/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to identify the factors associated with infection in patients who undergo penile prosthesis implantation. METHODS We performed a systematic review/meta-analysis, including clinical trials, quasi-experiments, retrospective and prospective cohort studies, and case-control studies. Searching was done in CENTRAL, MEDLINE, and EMBASE databases. Participants were patients who had erectile dysfunction, regardless of the etiology, and underwent penile prosthesis implantation. Two researchers reviewed each reference by title and abstract. The statistical analysis was performed using Review Manager 5.3 (RevMan® 5.3). RESULTS A total of 513 studies were found with the search strategies. After excluding duplicates, 40 studies with a total of 175,592 patients were included in the qualitative and quantitative analysis. Among patient characteristics, we found that diabetes mellitus and immunosuppression appear to have increase odds of infection. Related to the procedure, infection-retardant-coated penile prosthesis and primary (first) surgery appear to lower odds of infection. CONCLUSIONS Diabetes mellitus and immunosuppression were associated with increased infection rates; infection-retardant coating of the prosthesis and primary surgery were associated with reduced infection rates.
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Affiliation(s)
- Alejandro Carvajal
- Department of Urologic Surgery and Andrology, CES University, Medellin, Colombia
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16
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Krughoff K, Munarriz RM, Gross MS. An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide. Int J Impot Res 2020; 33:55-58. [PMID: 31896830 DOI: 10.1038/s41443-019-0226-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). We sought to determine common insurance coverage criteria and barriers to implantation across common insurance plans from healthcare referral regions (HRR) nationwide. Coverage criteria and stipulations were reviewed regarding erectile dysfunction (ED) etiology, ED duration, contributing comorbid conditions, medications, drug use, diagnostic tests, use of procedures and prior interventions. Seventy of 100 plans included coverage criteria. 36.1% provided coverage only in cases of gender dysphoria. 27.7% required documentation of trial, contraindication or intolerance to pharmacologic therapy, with varying descriptors of what this entailed. 13.8% required at least consideration of prior pharmacologic therapy. 4.2% required trial or contraindication to classic second-line therapies. 25.0% stated that ED must be organic. Psychogenic ED was covered by 12.5% of plans. Eleven plans required at least 6 or 12 months of symptoms. Laboratory evaluation to rule out hypogonadism or hyperprolactinemia was required by five plans. Insurance coverage criteria for PP placement were highly variable by state and plan. Coverage is provided for PP implantation in most cases for ED of organic etiology following failure of pharmacologic therapy when contributing comorbidities are optimally managed.
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Rezaee ME, Butaney M, Thirumavalavan N, Gross MS, Munarriz RM. Advances in Infection Prevention Strategies for Penile Prosthesis Surgery. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Preventing Infections in Prosthetic Surgery. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gross MS, Vollstedt AJ, Cleves MA, Glina S, Honig SC, Perito P, Stahl PJ, Gayá MR, Gheiler E, Ralph DJ, Köhler T, Stember DS, Carrion R, Maria P, Brant WO, Garber B, Burnett AL, Eid JF, Henry GD, Munarriz R. Multicenter investigation on the influence of climate in penile prosthesis infection. Int J Impot Res 2019; 32:387-392. [PMID: 31043705 DOI: 10.1038/s41443-019-0148-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022]
Abstract
The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed. We found that penile prosthesis infections occurred more commonly in June (n = 24) and less frequently during the winter months (n = 39), with the lowest number occurring in March (n = 11). One-hundred thirty-nine infections occurred at average daily temperatures greater than 55 °F, compared to 72 infections at less than 55 °F. The incidence rate ratio for this trend was 1.93, with a p-value of <0.001. Humidity results were similar, and fungal infections correlate with daily humidity. Infected implants performed in the fall and summer were over 3 and 2.3 times, respectively, more likely to grow Gram-positive bacteria compared to implants performed in spring (p = 0.004; p = 0.039). This was consistent across geographic location, including in the Southern hemisphere. We found trends between climate factors and IPP infection like those seen and proven in other surgical literature. To our knowledge these data represent the first exploration of the relationship between temperature and infection in prosthetic urology.
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Affiliation(s)
| | | | - Mario A Cleves
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sidney Glina
- Faculdade de Medicina do ABC/Instituto H.Ellis, São Paulo, Brazil
| | | | | | - Peter J Stahl
- Columbia University College of Physicians & Surgeons, New York City, NY, USA
| | | | | | | | | | | | | | - Pedro Maria
- Albert Einstein College of Medicine, New York City, NY, USA
| | | | - Bruce Garber
- Hahnemann University Hospital, Philadelphia, PA, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients. RECENT FINDINGS Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients. Substance abuse is correlated with increased risk of infection after penile implant surgery. Careful patient selection and preoperative optimization can reduce infection risk in spinal cord injury patients. In the last 5 years, there have been several important studies investigating the risk of penile prosthesis infection in complex patients, clarifying which patient categories are at increased risk and how that risk can be mitigated.
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Lipsky MJ, Onyeji I, Golan R, Munarriz R, Kashanian JA, Stember DS, Stahl PJ. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019; 7:35-40. [PMID: 30674445 PMCID: PMC6377380 DOI: 10.1016/j.esxm.2018.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile prosthesis (IPP) infection, the link between DM diagnosis and IPP infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP infection have not been published. AIM To evaluate the association of DM with IPP infection in a large public New York state database. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for men who underwent initial IPP insertion from 1995-2014. Diabetic patients were identified using ICD-9-CM codes. Patients presenting for first operation with diagnosis or Current Procedural Terminology codes suggestive of prior IPP surgery were excluded. Chi-squared analyses were performed to compare infection rates in diabetics and non-diabetics within the pre- and postantibiotic impregnated eras. Multivariate Cox proportional hazards models were constructed to evaluate whether or not DM was independently associated with IPP infection in the time periods before (1995-2003) and after (2004-2014) the widespread availability of antibiotic impregnated penile prostheses. MAIN OUTCOME MEASURE Time to prosthesis infection was measured. RESULTS 14,969 patients underwent initial IPP insertion during the study period. The overall infection rate was 343/14,969 (2.3%). Infections occurred at a median 3.9 months after implant (interquartile ratio: 1.0-25.0 months). Infectious complications were experienced by 3% (133/4,478) of diabetic patients and 2% (210/10,491) of non-diabetic patients (P < .001). Diabetes was associated with a significantly increased IPP infection risk on multivariable analysis controlling for age, race, comorbidities, insurance status, annual surgeon volume, and era of implantation (Hazard Ratio: 1.32, 95% CI: 1.05-1.66, P = .016). CONCLUSION Our analysis supports the notion that DM is a risk factor for IPP infection. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control before surgery. Lipsky MJ, Onyeji I, Golan R, et al. Diabetes Is a Risk Factor for Inflatable Penile Prosthesis Infection: Analysis of a Large Statewide Database. Sex Med 2019;7:35-40.
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Affiliation(s)
- Michael J Lipsky
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA.
| | - Ifeanyi Onyeji
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA
| | - Ron Golan
- Department of Urology, New York Presbyterian Hospital/ Weill Cornell Medical Center, New York, NY, USA
| | - Ricardo Munarriz
- Center for Sexual Medicine, Boston University School of Medicine, Department of Urology, Boston, MA, USA
| | - James A Kashanian
- Department of Urology, New York Presbyterian Hospital/ Weill Cornell Medical Center, New York, NY, USA
| | - Doron S Stember
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Peter J Stahl
- Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA
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Infection Prevention Strategies Prior to Penile Implant Surgery. Eur Urol Focus 2018; 4:317-320. [DOI: 10.1016/j.euf.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 01/26/2023]
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