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[Penile prostheses and infection]
Yann Schoepen1, Frédéric Staerman
1Département d'Urologie-Andrologie, Hôpital Robert Debré, avenue du Général Koenig, 51092-Reims.
Abstract:
Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week and presents in the form of frank clinical features (pain, erythema, penile discharge); highly virulent bacteria are isolated, such as Staphylococcus aureus. Late sepsis occurs after an interval of several weeks to several months with less specific clinical features; Staphylococcus epidermidis is isolated in more than 50% of cases. Conventional treatment of these infections consists of antibiotics adapted to the local flora and removal of the prosthesis, sometimes followed by deferred reimplantation. Prosthetic material salvage procedures are now proposed. Patient-related risk factors for infection include diabetes, urinary tract infection and immunodepression, while procedure-related risk factors include the length of hospital stay, poor operative technique, prolonged operating time and iatrogenic urethral injuries. Prevention of sepsis of penile prostheses is based on prevention of these risk factors and prophylactic antibiotics or prolonged antibiotic therapy.
Insights
Penile prosthesis infections, a major complication, can be early or late, caused by different bacteria. Prevention focuses on managing risk factors and antibiotic strategies.
Area of Science:
- Urology
- Infectious Diseases
- Biomaterials Science
Context:
- Penile prosthesis implantation is a treatment for erectile dysfunction.
- Prosthetic joint infections are a significant concern, with penile prostheses experiencing an estimated 3% infection rate.
- Understanding infection timelines and causative agents is crucial for effective management.
Purpose:
- To review the epidemiology, clinical presentation, and management of penile prosthesis infections.
- To identify patient- and procedure-related risk factors associated with prosthesis infection.
- To discuss current and emerging treatment strategies, including salvage procedures and preventative measures.
Summary:
- Early penile prosthesis infections (within the first week) present with acute symptoms and are often caused by Staphylococcus aureus.
- Late infections (weeks to months post-implantation) have less specific symptoms and are frequently associated with Staphylococcus epidermidis.
- Treatment traditionally involves antibiotics and prosthesis removal, but prosthetic material salvage is an alternative. Risk factors include diabetes, UTIs, immunodepression, and surgical factors like prolonged operating time.
Impact:
- Informed clinical decision-making for preventing and treating penile prosthesis infections.
- Highlights the importance of meticulous surgical technique and patient risk factor management.
- Provides insights into antibiotic prophylaxis and therapeutic strategies to improve patient outcomes and reduce complications.