Miguel Pineda1, Arthur L Burnett2. 1. The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA. 2. The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: aburnet1@jhmi.edu.
Abstract
INTRODUCTION: Inflatable penile prosthesis (IPP) surgery has been performed for more than 40 years. IPP infection rates have decreased owing to advances in manufacturing and surgical technique but have remained a devastating complication. AIMS: To describe the pathophysiology of infections, examine evidence associating clinical risk factors with IPP infection, assess the benefit of techniques aimed at preventing and managing infection, and discuss future directions. METHODS: PubMed and Google Scholar were searched for studies relating to IPP infections. MAIN OUTCOME MEASURES: A comprehensive review of the literature on IPP infections focusing on predisposing factors and ways to prevent and treat. RESULTS: There are two types of IPP infections: those caused by coagulase-negative Staphylococcus species, which present mildly, and those caused by organisms that are more virulent and systemically toxic. Biofilm on devices protects bacteria from immunologic responses and antibiotics. Much research has targeted biofilm. Spinal cord injury, IPP revision, and longer operative times predispose to IPP infection. Other factors, such as diabetes, immunosuppression, and concomitant surgeries, lack sufficient evidence to determine conclusively. Methods that decrease infections include using infused prostheses and adhering to surgical techniques that avoid prolonged wound exposure. Techniques that might prevent IPP infection but lack definitive evidence are using postoperative antibiotics past 24 hours, shaving with clippers, and prepping with chlorhexidine-alcohol. Different treatments for IPP infections exist. Antibiotics should be followed by explantation if no improvement occurs. Device replacement can be immediate or delayed depending on infection severity and other variables such as erosion. Various techniques are proposed to prevent corporal fibrosis after IPP removal. CONCLUSION: We reviewed studies to determine true risk factors and the techniques that have true impact on infection prevention. Newer studies focusing on prevention and disruption of biofilm will be key in advancing the best outcomes.
INTRODUCTION: Inflatable penile prosthesis (IPP) surgery has been performed for more than 40 years. IPP infection rates have decreased owing to advances in manufacturing and surgical technique but have remained a devastating complication. AIMS: To describe the pathophysiology of infections, examine evidence associating clinical risk factors with IPP infection, assess the benefit of techniques aimed at preventing and managing infection, and discuss future directions. METHODS: PubMed and Google Scholar were searched for studies relating to IPP infections. MAIN OUTCOME MEASURES: A comprehensive review of the literature on IPP infections focusing on predisposing factors and ways to prevent and treat. RESULTS: There are two types of IPP infections: those caused by coagulase-negative Staphylococcus species, which present mildly, and those caused by organisms that are more virulent and systemically toxic. Biofilm on devices protects bacteria from immunologic responses and antibiotics. Much research has targeted biofilm. Spinal cord injury, IPP revision, and longer operative times predispose to IPP infection. Other factors, such as diabetes, immunosuppression, and concomitant surgeries, lack sufficient evidence to determine conclusively. Methods that decrease infections include using infused prostheses and adhering to surgical techniques that avoid prolonged wound exposure. Techniques that might prevent IPP infection but lack definitive evidence are using postoperative antibiotics past 24 hours, shaving with clippers, and prepping with chlorhexidine-alcohol. Different treatments for IPP infections exist. Antibiotics should be followed by explantation if no improvement occurs. Device replacement can be immediate or delayed depending on infection severity and other variables such as erosion. Various techniques are proposed to prevent corporal fibrosis after IPP removal. CONCLUSION: We reviewed studies to determine true risk factors and the techniques that have true impact on infection prevention. Newer studies focusing on prevention and disruption of biofilm will be key in advancing the best outcomes.
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