Introduction

The inflatable penile prosthesis (IPP) is the gold standard for the treatment of chronic erectile dysfunction (ED) that does not respond to oral medications. Nevertheless, IPP implantation is not without risk of infection, a complication that can cause significant side effects and distress for patients.

Antibiotic-coated implants were introduced to lower the risk of IPP infection, and they have had a positive effect on reducing infection rates overall. However, these devices seem to have changed the timing of IPP infections and the microbial profiles present when infections do occur. To determine how the current perioperative antimicrobial protocols of an institution affect the timing and causative organisms of IPP infection, researchers from this institution completed a retrospective study of 1,071 IPP patients.

Methods

For this study, researchers reviewed the medical data of all of the patients (n=1,071) who underwent IPP placement in their institution between January 2014 and January 2022. All of these patients received treatment that was compliant with the American Urological Association’s guidelines on IPP perioperative antimicrobial administration. For Boston Scientific implants, all devices were impregnated with InhibiZone (rifampin and minocycline), and all Coloplast devices were soaked in rifampin and gentamicin.

The researchers documented the patients’ ages, clinical characteristics, comorbidities, and whether or not they experienced IPP infection. If the patients did experience IPP infection, the timing and the microbial profile of the infection was documented as well.

Results

Ultimately, the authors found that of the 1,071 patients who had undergone IPP implantation in this 8-year period, 2.6% (28/1,071) experienced an infection. Infections were more common before Betadine was discontinued and the new perioperative antimicrobial protocols were introduced. The infection rate of those who received the Betadine was 13.2% (20/152), while the infection rate of those who had an IPP placed after the discontinuation of Betadine was 0.9% (8/919).

The median time to experiencing symptoms of infection was 36 days after surgery, which was delayed compared to IPP infections of the past. Overall, 30% of the patients experienced systemic symptoms like fever and chills.

Just under half (46.4%) of the infections were first-time IPPs, 71.4% included Betadine, and 50% were patients who had diabetes mellitus. The median age of the patients who experienced IPP infection was 66 years.

Lastly, the authors noted that organisms with high virulence (or ability to cause disease) were found in 90.5% of the positive cultures, which was a shift from previous IPP infections that were often related to organisms with lower virulence.

Discussion & Conclusion

These results suggest that while IPP infection may occur less often with antibiotic-coated devices, the nature of IPP infections may be changing. The authors of this study summarized, “These findings demonstrate that the onset of symptoms in penile prosthesis infection occurs in a delayed fashion between 1 and 2 months despite the rising prevalence of virulent organisms. Virulent organisms dominated 90% of positive intraoperative cultures in our series, confirming a microbial profile trend since the development of antibiotic-coated devices. These findings suggest that high-volume implanters need to reflect on their institutional perioperative antibiotic protocols in the contemporary prosthetic device era.”

References:

• Bole MD, R., Habashy MD, E., Yang MD, D., Ahmed MBBCh, M., Trost MD, L., Ziegelmann MD, M., Helo MD, S., & Kohler MD, T. (2023). Timing and causative organisms associated with modern inflatable penile prosthesis infection: an institutional retrospective. The Journal of Sexual Medicine, 20(1), 107-112. https://doi.org/10.1093/jsxmed/qdac001