Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Prospective analysis of cultures from the Furlow insertion tool: a possible etiology for penile prosthesis infections

International Journal of Impotence Research volume 33, pages 291–295 (2021)Cite this article

Subjects

Abstract

The most dreaded complication of penile prosthesis (PP) implantation is device infection. We sought to assess whether inadequate cleaning and sterilization of the reusable Furlow inserter may represent one of the last etiologies of infection in PP patients. We performed a prospective analysis of cultures of the Furlow inserter used for PP surgeries from seven centers between May 1st and June 30th, 2019. Once the Furlow was received for surgery, the surgical team inspected the device for assembly status (disassembled or not) and the presence of visible stains, pieces of tissue or discoloration on either the interior of the barrel or the plunger. Swab aerobic and anaerobic bacterial and fungal cultures were then obtained from the internal component, after removal from the external component if assembled, and after introduction and immediate removal from the external component if disassembled. A total of 83 Furlow devices were cultured. Median age of surgical instrument was 4 years (2–10 years). Methods of sterilization included autoclave, wet autoclave, steam, and Sterad. Median time from sterilization was 3 days (1–22). On initial presentation, 79 devices were disassembled (95.1%) and 4 devices were still assembled (4.9%). Three external components were discolored (3.6%), while internal components demonstrated two stains (2.4%) indicative of improper cleaning which were thought to be residual blood products. Overall, 2/83 (2.4%) devices revealed positive swab cultures for Staphylococcus epidermidis. Swab cultures were negative for fungi and anaerobic bacteria. This patient cohort will continue to be followed to see if device infection occurs but it is unlikely to be meaningful since contaminated Furlows were discarded. Improper cleaning and/or sterilization of the Furlow Insertion Instrument may represent a source of infection for patients undergoing PP implantation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Swab cultures obtained from the internal component, after removal from the external component if assembled.
Fig. 2: Swab cultures obtained from the internal component after introduction and immediate removal from the external component if disassembled.
Fig. 3

Similar content being viewed by others

References

  1. Eid JF. No-touch technique. J Sex Med. 2011;8:5–8. https://doi.org/10.1111/j.1743-6109.2010.02137.x.

    Article  PubMed  Google Scholar 

  2. Katz DJ, Stember DS, Nelson CJ, Mulhall JP. Perioperative prevention of penile prosthesis infection: practice patterns among surgeons of SMSNA and ISSM. J Sex Med. 2012;9:1705–12. https://doi.org/10.1111/j.1743-6109.2012.02724.x. quiz 1712–1704.

    Article  PubMed  Google Scholar 

  3. 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;188:1855–60. https://doi.org/10.1016/j.juro.2012.07.022.

    Article  PubMed  Google Scholar 

  4. Wolf JS Jr., Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179:1379–90. https://doi.org/10.1016/j.juro.2008.01.068.

    Article  PubMed  Google Scholar 

  5. Lipsky MJ, Onyeju I, Golan R, Munarriz R, 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.

    Article  Google Scholar 

  6. Carson CC 3rd, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185:614–8. https://doi.org/10.1016/j.juro.2010.09.094.

    Article  PubMed  Google Scholar 

  7. Wilson SK, Delk JRI. Historical advances in penile prostheses. Int J Impot Res. 2000;12(Suppl 4):S101–7.

    Article  Google Scholar 

  8. Rutala WA, Weber DJ, HICPAC. Guideline for disinfection and sterilization in healthcare facilities, 2008. CDC guidelines; 2019. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/.

  9. Al Qahtani SH, Abdelhamied MH, AlMuhrij AH, Al Rawashada MY, Al Askar AM, Abdelhamid AM, et al. Prospective comparative study between the effect of CIDEX OPA and STERRAD NX on the durability of digital flexible ureteroscope. World J Urol. 2019. https://doi.org/10.1007/s00345-019-020800-z.

  10. Okpara-Hofmann J, Knoll M, Durr M, Schmitt B, Borneff-Lipp M. Comparison of low-temperature hydrogen peroxide gas plasma sterilization for endoscopes using various Sterrad models. J Hosp Infect. 2005;59:208–85.

    Article  Google Scholar 

  11. Kleinegger CL, Yeager DL, Huling JK, Drake DR. The effects of contamination on biological monitoring. Infect Control Hosp Epidemiol. 2001;22:391–2.

    Article  CAS  Google Scholar 

  12. Veena Kumari HB, Nagarathna S, Chandramouli BA, Umamaheshwara Rao GS, Chandramuki A. Investigation of an outbreak of device-related postoperative ventriculitis: a lesson learnt. Indian J Pathol Microbiol. 2008;64:344–7.

    Google Scholar 

  13. Vijayaraghavan R, Chandrashekhar R, Sujatha Y, Belagavi CS. Hospital outbreak of atypical mycobacterial infection of port sites after laparoscopic surgery. J Hosp Infect. 2006;64:344–7. https://doi.org/10.1016/j.jhin.2006.07.021.

    Article  CAS  PubMed  Google Scholar 

  14. Saito Y, Kobayashi H, Uetera Y, Yasuhara H, Kajiura T, Okubo T. Microbial contamination of surgical instruments used for laparotomy. Am J Infect Control. 2014;42:43–7. https://doi.org/10.1016/j.ajic.2013.06.022.

    Article  PubMed  Google Scholar 

  15. 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;172:153–6. https://doi.org/10.1097/01.ju.0000132141.48587.f1.

    Article  PubMed  Google Scholar 

  16. 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;14:455–63. https://doi.org/10.1016/j.jsxm.2017.01.007.

    Article  PubMed  Google Scholar 

  17. Forrester JA, Powell BL, Forrester JD, Fast C, Weiser TG. Surgical instrument reprocessing in resource-constrained countries: a scoping review of existing methods, policies, and barriers. Surg Infect. 2018;19:593–602. https://doi.org/10.1089/sur.2018.078.

    Article  Google Scholar 

  18. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection. Am J Infect Control. 1999;27:97–134.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of California Irvine, Irvine, CA, USA

    Faysal A. Yafi & Farouk M. El-Khatib

  2. University of Oklahoma, Oklahoma City, OK, USA

    James Furr

  3. Jessa Hospital, Hasselt, Belgium

    Koenraad van Renterghem

  4. University College London Hospital, London, England

    Luca Venturino & David Ralph

  5. University Hospital of Liège, Liege, Belgium

    Robert Andrianne & Maxime Sempels

  6. University Hospital Schleswig-Holstein, Kiel, Germany

    Daniar Osmonov

  7. Hospital Universitario 12 de Octubre, Madrid, Spain

    Javier Romero Otero

  8. Martha-Maria Hospital, University of Erlangen-Nuremberg, Nuremberg, Germany

    Georgios Hatzichristodoulou

  9. Duke Raleigh Hospital, Raleigh, NC, USA

    Aaron Lentz

  10. Institute for Urologic Excellence, La Quinta, CA, USA

    Steven K. Wilson

Authors
  1. Faysal A. Yafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Furr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farouk M. El-Khatib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koenraad van Renterghem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Venturino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Andrianne
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniar Osmonov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Ralph
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Javier Romero Otero
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maxime Sempels
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Georgios Hatzichristodoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Aaron Lentz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Steven K. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Faysal A. Yafi.

Ethics declarations

Conflict of interest

FAY reports associations with Endo Pharmaceuticals as consultant and speaker; Antares Pharma as consultant and speaker; Coloplast as speaker and advisory board; and Viome Inc. as trial primary investigator. All other authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yafi, F.A., Furr, J., El-Khatib, F.M. et al. Prospective analysis of cultures from the Furlow insertion tool: a possible etiology for penile prosthesis infections. Int J Impot Res 33, 291–295 (2021). https://doi.org/10.1038/s41443-020-0256-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-0256-2

This article is cited by

Search

Advanced search

Quick links