Abstract
Inflatable penile prosthesis (IPP) infections are undeniably devastating for patient and surgeon alike. While less common in this modern era, the landscape of prosthesis infection is shifting. Continued examination of risk factors for infection and re-evaluation of common practices remain critical should we aim to advance the field. Quality research on this topic is limited by several factors, among which small sample size and lack of coordinated effort pose the most precarious of challenges. Nonetheless, careful analysis of available data in conjuncture with judicious utilization of established research from other prosthetic fields can help us better grasp the issue at hand. In this review, we aim to do exactly that—to examine available evidence in an effort to discern fact from fiction. In this first part of the three part series, we aim to summarize our understanding of the pathogenesis behind prosthesis infections, explore known preoperative risk factors, and discuss intraoperative considerations for infection prevention. In the second part of this series, we will examine the game changing effect of infection retardant implant coatings. Part three of the series details postoperative prevention strategies, reviews salvage techniques, and discusses additional key considerations.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Li K, Brandes ER, Chang SL, Leow JJ, Chung BI, Wang Y, et al. Trends in penile prosthesis implantation and analysis of predictive factors for removal. World J Urol. 2019;37:639–46.
Lee DJ, Najari BB, Davison WL, Al Hussein Al Awamlh B, Zhao F, Paduch DA, et al. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. J Sex Med. 2015;12:1638–45.
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;193:2040–4.
Darouiche RO. Antimicrobial approaches for preventing infections associated with surgical implants. Clin Infect Dis. 2003;36:1284–9.
Ziegelmann M, Kohler TS, Bailey GC, Miest T, Alom M, Trost L. Surgical patient selection and counseling. Transl Androl Urol. 2017;6:609–19.
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;30:147–52.
Silverstein AD, Henry GD, Evans B, Pasmore M, Simmons CJ, Donatucci CF. Biofilm formation on clinically noninfected penile prostheses. J Urol. 2006;176:1008–11.
Arciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol. 2018;16:397–409.
Wilson SK, Costerton JW. Biofilm and penile prosthesis infections in the era of coated implants: a review. J Sex Med. 2012;9:44–53.
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.
Wolter CE, Hellstrom WJ. The hydrophilic-coated inflatable penile prosthesis: 1-year experience. J Sex Med. 2004;1:221–4.
Kava BR, Kanagarajah P, Ayyathurai R. Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single-surgeon series. J Sex Med. 2011;8:1540–6.
Thammavongsa V, Missiakas DM, Schneewind O. Staphylococcus aureus degrades neutrophil extracellular traps to promote immune cell death. Science. 2013;342:863–6.
Wilson SK, Delk JR 2nd. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol 1995;153:659–61.
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.
Osman MM, Huynh LM, El-Khatib FM, Towe M, Su HW, Andrianne R, et al. Immediate preoperative blood glucose and hemoglobin a1c levels are not predictive of postoperative infections in diabetic men undergoing penile prosthesis placement. Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0261-5.
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;60:167–72.
OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653.
Sorensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147:373–83.
Silverstein A, Henry GD, Delk JR, Wilson S, 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.
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;29:373–82.
Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25:1458–63.
Angulo J, Gonzalez-Corrochano R, Cuevas P, Fernandez A, La Fuente JM, Rolo F, et al. Diabetes exacerbates the functional deficiency of NO/cGMP pathway associated with erectile dysfunction in human corpus cavernosum and penile arteries. J Sex Med. 2010;7:758–68.
Lipsky MJ, Onyeji I, Golan R, Munarriz R, Kashanian JA, Stember DS, et al. Diabetes Is a risk factor for inflatable penile prosthesis infection: analysis of a large statewide database. Sex Med. 2019;7:35–40.
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.
Canguven O, Talib R, El Ansari W, Khalafalla K, Al Ansari A. Is Hba1c level of diabetic patients associated with penile prosthesis implantation infections. Aging Male. 2018:1–6. https://doi.org/10.1080/13685538.2018.1448059.
Collins KP, Hackler RH. Complications of penile prostheses in the spinal cord injury population. J Urol. 1988;140:984–5.
Yousif A, Raheem OA. RE: neurogenic bladder is an independent risk factor for complications associated with inflatable penile prosthesis implantation. Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0240-x.
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;41:167–73.
Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2015;2:CD004985.
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;15:1049–54.
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;470:1507–12.
Sidi AA, Peng W, Sanseau C, Lange PH. Penile prosthesis surgery in the treatment of impotence in the immunosuppressed man. J Urol. 1987;137:681–2.
Cuellar DC, Sklar GN. Penile prosthesis in the organ transplant recipient. Urology. 2001;57:138–41.
Wolf JS Jr., Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179:1379–90.
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;6:157–61.
Tanner J, Dumville JC, Norman G, Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2016;1:CD004288.
Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;11:CD004122.
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;189:136–40.
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.
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.
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.
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;347:1133–7.
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.
Garber BB, Marcus SM. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology. 1998;52:291–3.
Thomalla JV, Thompson ST, Rowland RG, Mulcahy JJ. Infectious complications of penile prosthetic implants. J Urol. 1987;138:65–7.
Weinberg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Sub-coronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med. 2016;13:270–6.
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;17:535–8.
Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2007;3:CD001825.
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;197:223–9.
Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplast. 2019;34:947–53.
Pan S, Rodriguez D, Thirumavalavan N, Gross MS, Eid JF, Mulcahy J, et al. The use of antiseptic solutions in the prevention and management of penile prosthesis infections: a review of the cytotoxic and microbiological effects of common irrigation solutions. J Sex Med. 2019;16:781–90.
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;79:1310–5.
Kim K, Zhu M, Munro JT, Young SW. Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review. ANZ J Surg. 2019;89:1009–15.
Gawande A. The checklist manifesto: how to get things right. 1st ed. New York: Metropolitan Books; 2010. p. 209.
Katz BF, Gaunay GS, Barazani Y, Nelson CJ, Moreira DM, Dinlenc CZ, et al. Use of a preoperative checklist reduces risk of penile prosthesis infection. J Urol. 2014;192:130–5.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
TSK is a consultant for Boston Scientific and Coloplast. SKW is a consultant for AMT, Coloplast, and International Medical Devices. He is also a lecturer for Boston Scientific, and a NeoTract Stockholder. The other author declare that he has 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
About this article
Cite this article
Köhler, T.S., Wen, L. & Wilson, S.K. Penile implant infection prevention part 1: what is fact and what is fiction? Wilson’s Workshop #9. Int J Impot Res 33, 785–792 (2021). https://doi.org/10.1038/s41443-020-0326-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-020-0326-5