World J Mens Health.  2019 Sep;37(3):276-287. 10.5534/wjmh.180123.

Penile Prosthesis Infection: Myths and Realities

Affiliations
  • 1Department of Urology, Mayo Clinic, Rochester, MN, USA. Kohler.Tobias@mayo.edu

Abstract

Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), Staphylococcus aureus nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), "No Touch" technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.

Keyword

Erectile dysfunction; Infection; Penile implant; Penile prosthesis; Sexual dysfunction, physiological

MeSH Terms

Anti-Bacterial Agents
Erectile Dysfunction
Evidence-Based Medicine
Hair Removal
Hand
Health Care Costs
Humans
Immunosuppression
Male
Obesity
Penile Prosthesis*
Prostheses and Implants
Risk Factors
Sexual Dysfunction, Physiological
Smoke
Smoking
Spinal Cord Injuries
Staphylococcus aureus
Stress, Psychological
T-Lymphocytes
Tobacco
Urinary Diversion
Anti-Bacterial Agents
Smoke

Cited by  1 articles

Diagnosis and treatment of sexual dysfunction in elderly men
Hyun Jun Park
J Korean Med Assoc. 2019;62(6):308-314.    doi: 10.5124/jkma.2019.62.6.308.


Reference

1. Bettocchi C, Palumbo F, Spilotros M, Lucarelli G, Palazzo S, Battaglia M, et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J Sex Med. 2010; 7:304–309.
Article
2. Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group. J Urol. 2000; 164:376–380.
3. Lindeborg L, Fode M, Fahrenkrug L, Sønksen J. Satisfaction and complications with the Titan® one-touch release penile implant. Scand J Urol. 2014; 48:105–109.
Article
4. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol. 2018; 200:633–641.
Article
5. Montague DK, Angermeier KW, Lakin MM. Penile prosthesis infections. Int J Impot Res. 2001; 13:326–328.
Article
6. OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2 [Internet]. Oxford: Oxford Centre for Evidence-Based Medicine;2011. cited 2018 Oct 25. Available from: https://www.cebm.net/index.aspx?o=5653.
7. Chlebicki MP, Safdar N, O'Horo JC, Maki DG. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control. 2013; 41:167–173.
Article
8. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2015; (2):CD004985.
Article
9. Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine. J Sex Med. 2016; 13:489–518.
Article
10. Turan A, Mascha EJ, Roberman D, Turner PL, You J, Kurz A, et al. Smoking and perioperative outcomes. Anesthesiology. 2011; 114:837–846.
Article
11. Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012; 147:373–383.
12. Kigera JW, Straetemans M, Vuhaka SK, Nagel IM, Naddumba EK, Boer K. Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis. PLoS One. 2012; 7:e42254.
Article
13. Guild GN, Moore TJ, Barnes W, Hermann C. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res. 2012; 470:1507–1512.
Article
14. Silverstein A, Henry GD, Delk JR, Wilson SK, Donatucci CF. Nasal carriage of Staphylococcus aureus as a potential risk factor for infection after penile prosthesis placement. Int J Impot Res. 2002; 14:S61.
15. Berthelot P, Grattard F, Cazorla C, Passot JP, Fayard JP, Meley R, et al. Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery? Eur J Clin Microbiol Infect Dis. 2010; 29:373–382.
Article
16. Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, et al. Preventing surgicalsite infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010; 362:9–17.
17. Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996; 156:402–404.
Article
18. Wilson SK, Delk JR 2nd. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995; 153:659–661.
Article
19. Wilson SK, Zumbe J, Henry GD, Salem EA, Delk JR, Cleves MA. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology. 2007; 70:337–340.
Article
20. Thomalla JV, Thompson ST, Rowland RG, Mulcahy JJ. Infectious complications of penile prosthetic implants. J Urol. 1987; 138:65–67.
Article
21. Eid JF, Wilson SK, Cleves M, Salem EA. Coated implants and “no touch” surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%. Urology. 2012; 79:1310–1315.
Article
22. Henry GD, Wilson SK, Delk JR 2nd, Carson CC, Silverstein A, Cleves MA, et al. Penile prosthesis cultures during revision surgery: a multicenter study. J Urol. 2004; 172:153–156.
Article
23. Montgomery BD, Lomas DJ, Ziegelmann MJ, Trost LW. Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories. Int J Impot Res. 2018; 30:147–152.
Article
24. Henry GD, Wilson SK, Delk JR 2nd, Carson CC, Wiygul J, Tornehl C, et al. Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study. J Urol. 2005; 173:89–92.
Article
25. Gross MS, Phillips EA, Balen A, Eid JF, Yang C, Simon R, et al. The malleable implant salvage technique: infection outcomes after mulcahy salvage procedure and replacement of infected inflatable penile prosthesis with malleable prosthesis. J Urol. 2016; 195:694–697.
Article
26. Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, Levine LA, et al. Multicenter investigation of the micro-organisms involved in penile prosthesis infection: an analysis of the efficacy of the AUA and EAU guidelines for penile prosthesis prophylaxis. J Sex Med. 2017; 14:455–463.
27. McManus LM, Bloodworth RC, Prihoda TJ, Blodgett JL, Pinckard RN. Agonist-dependent failure of neutrophil function in diabetes correlates with extent of hyperglycemia. J Leukoc Biol. 2001; 70:395–404.
28. Barbul A, Efron DT, Kavalukas SL. Wound healing. In : Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, editors. Schwartz's principles of surgery. 10th ed. New York: McGraw-Hill Education;2014.
29. Mulcahy JJ, Carson CC 3rd. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011; 60:167–172.
Article
30. Garber BB, Marcus SM. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology. 1998; 52:291–293.
Article
31. Bishop JR, Moul JW, Sihelnik SA, Peppas DS, Gormley TS, McLeod DG. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992; 147:386–388.
Article
32. Wilson SK, Carson CC, Cleves MA, Delk JR 2nd. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol. 1998; 159:1537–1539. discussion 1539-40.
Article
33. Habous M, Tal R, Tealab A, Soliman T, Nassar M, Mekawi Z, et al. Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection. BJU Int. 2018; 121:293–300.
Article
34. Goldstein I, Feldman MI, Deckers PJ, Babayan RK, Krane RJ. Radiation-associated impotence. A clinical study of its mechanism. JAMA. 1984; 251:903–910.
Article
35. McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, Breyer BN. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014; 192:1756–1761.
Article
36. Rivera ME, Linder BJ, Ziegelmann MJ, Viers BR, Rangel LJ, Elliott DS. The impact of prior radiation therapy on artificial urinary sphincter device survival. J Urol. 2016; 195:1033–1037.
Article
37. Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology. 2014; 84:934–938.
Article
38. Dubocq FM, Bianco FJ Jr, Maralani SJ, Forman JD, Dhabuwala CB. Outcome analysis of penile implant surgery after external beam radiation for prostate cancer. J Urol. 1997; 158:1787–1790.
Article
39. Loh-Doyle J, Patil MB, Nakhoda Z, Nassiri N, Yip W, Wayne K, et al. Three-piece inflatable penile prosthesis placement following pelvic radiation: technical considerations and contemporary outcomes. J Sex Med. 2018; 15:1049–1054.
Article
40. Loh-Doyle J, Patil MB, Sawkar H, Wayne K, Boyd SD. 3-piece inflatable penile prosthesis placement following radical cystoprostatectomy and urinary diversion: technique and outcomes. J Sex Med. 2018; 15:907–913.
Article
41. Biering-Sørensen F, Sønksen J. Sexual function in spinal cord lesioned men. Spinal Cord. 2001; 39:455–470.
Article
42. Collins KP, Hackler RH. Complications of penile prostheses in the spinal cord injury population. J Urol. 1988; 140:984–985.
Article
43. Radomski SB, Herschorn S. Risk factors associated with penile prosthesis infection. J Urol. 1992; 147:383–385.
44. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017; (288):1–8.
45. Yuan K, Chen HL. Obesity and surgical site infections risk in orthopedics: a meta-analysis. Int J Surg. 2013; 11:383–388.
Article
46. Gurunathan U, Ramsay S, Mitrić G, Way M, Wockner L, Myles P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg. 2017; 21:1700–1712.
Article
47. Tobian AA, Gray RH, Quinn TC. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision. Arch Pediatr Adolesc Med. 2010; 164:78–84.
Article
48. Douglawi A, Masterson TA. Updates on the epidemiology and risk factors for penile cancer. Transl Androl Urol. 2017; 6:785–790.
Article
49. Weinberg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Subcoronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med. 2016; 13:270–276.
Article
50. Sidi AA, Peng W, Sanseau C, Lange PH. Penile prosthesis surgery in the treatment of impotence in the immunosuppressed man. J Urol. 1987; 137:681–682.
Article
51. Cuellar DC, Sklar GN. Penile prosthesis in the organ transplant recipient. Urology. 2001; 57:138–141.
Article
52. Vincent GK, Velkoff VA. The next four decades: the older population in the United States: 2010 to 2050. Washington: Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau;2010. p. 25–1138.
53. Ginaldi L, De Martinis M, D'Ostilio A, Marini L, Loreto MF, Martorelli V, et al. The immune system in the elderly: II. Specific cellular immunity. Immunol Res. 1999; 20:109–115.
54. Chung E, Solomon M, DeYoung L, Brock GB. Clinical outcomes and patient satisfaction rates among elderly male aged ≥75 years with inflatable penile prosthesis implant for medically refractory erectile dysfunction. World J Urol. 2014; 32:173–177.
55. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–1390.
Article
56. Kavoussi NL, Viers BR, Pagilara TJ, Siegel JA, Hofer MD, Cordon B, et al. Are urine cultures necessary prior to urologic prosthetic surgery? Sex Med Rev. 2018; 6:157–161.
Article
57. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011; (11):CD004122.
Article
58. Yeung LL, Grewal S, Bullock A, Lai HH, Brandes SB. A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial. J Urol. 2013; 189:136–140.
Article
59. Paocharoen V, Mingmalairak C, Apisarnthanarak A. Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. J Med Assoc Thai. 2009; 92:898–902.
60. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010; 362:18–26.
Article
61. Tanner J, Dumville JC, Norman G, Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2016; (1):CD004288.
Article
62. Mandava SH, Serefoglu EC, Freier MT, Wilson SK, Hellstrom WJ. Infection retardant coated inflatable penile prostheses decrease the incidence of infection: a systematic review and meta-analysis. J Urol. 2012; 188:1855–1860.
Article
63. Jani K, Smith C, Delk JR 2nd, Carson CC, Donatucci CF, Cleves MA, et al. Infection retardant coatings impact on bacterial presence in penile prosthesis surgery: a multicenter study. Urology. 2018; 119:104–108.
Article
64. Boxma H, Broekhuizen T, Patka P, Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet. 1996; 347:1133–1137.
Article
65. Yerdel MA, Akin EB, Dolalan S, Turkcapar AG, Pehlivan M, Gecim IE, et al. Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial. Ann Surg. 2001; 233:26–33.
66. Henry GD. The Henry mummy wrap and the Henry finger sweep surgical techniques. J Sex Med. 2009; 6:619–622.
67. Sadeghi-Nejad H, Ilbeigi P, Wilson SK, Delk JR, Siegel A, Seftel AD, et al. Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery. Int J Impot Res. 2005; 17:535–538.
Article
68. LaPar DJ, Ailawadi G, Isbell JM, Crosby IK, Kern JA, Rich JB, et al. Mitral valve repair rates correlate with surgeon and institutional experience. J Thorac Cardiovasc Surg. 2014; 148:995–1003. discussion 1003-4.
Article
69. Sgroi MD, Darby GC, Kabutey NK, Barleben AR, Lane JS 3rd, Fujitani RM. Experience matters more than specialty for carotid stenting outcomes. J Vasc Surg. 2015; 61:933–938.
Article
70. Cahill PJ, Pahys JM, Asghar J, Yaszay B, Marks MC, Bastrom TP, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2014; 96:1333–1339.
Article
71. Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National practice patterns of treatment of erectile dysfunction with penile prosthesis implantation. J Urol. 2015; 193:2040–2044.
Article
72. McAbee KE, Pearlman AM, Terlecki RP. Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training. Investig Clin Urol. 2018; 59:342–347.
Article
73. Onyeji IC, Sui W, Pagano MJ, Weinberg AC, James MB, Theofanides MC, et al. Impact of surgeon case volume on reoperation rates after inflatable penile prosthesis surgery. J Urol. 2017; 197:223–229.
Article
74. Caire AA, Boonjindasup A, Hellstrom WJ. Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction? Int J Impot Res. 2011; 23:39–42.
Article
75. Brant MD, Ludlow JK, Mulcahy JJ. The prosthesis salvage operation: immediate replacement of the infected penile prosthesis. J Urol. 1996; 155:155–157.
Article
76. Mulcahy JJ. Long-term experience with salvage of infected penile implants. J Urol. 2000; 163:481–482.
Article
77. Köhler TS, Modder JK, Dupree JM, Bush NC, McVary KT. Malleable implant substitution for the management of penile prosthesis pump erosion: a pilot study. J Sex Med. 2009; 6:1474–1478.
Article
78. Kaufman JM, Kaufman JL, Borges FD. Immediate salvage procedure for infected penile prosthesis. J Urol. 1998; 159:816–818.
Article
79. Knoll LD. Penile prosthetic infection: management by delayed and immediate salvage techniques. Urology. 1998; 52:287–290.
Article
80. Habous M, Farag M, Williamson B, Laban O, Mahmoud S, Abdelwahab O, et al. Conservative therapy is an effective option in patients with localized infection after penile implant surgery. J Sex Med. 2016; 13:972–976.
Article
Full Text Links
  • WJMH
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr