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


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.

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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


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Correspondence to Faysal A. Yafi.

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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.

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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).

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