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Penile prosthesis cultures during revision surgery: a multicenter study
Gerard D Henry1, Steven K Wilson, John R Delk
1Institute for Urologic Excellence, Van Buren, Arkansas, USA. GDHenry@hotmail.com
Purpose:
Initial implantation of inflatable penile prosthesis has a 3% risk of infection. Reoperation of penile implants has a higher rate of infection, estimated between 10% and 18%. To explain the higher risk in revision surgery in this prospective study we cultured clinically uninfected prostheses requiring revision. Prosthesis pain was also investigated as a predictor of positive culture.
Materials And Methods:
At 3 institutions cultures were prospectively obtained from 77 clinically uninfected penile prostheses at revision surgery. Immediately upon surgical exposure of the pump cultures were obtained. If a bacterial biofilm was noted on any component it was additionally cultured. All culture isolates positive for a staphylococcus species were tested for sensitivity to rifampin and tetracycline (minocycline). An implant is now available that is coated with these antibiotics. Patient history of chronic prosthesis pain was ascertained.
Results:
Culture positive bacteria were found in 54 of 77 (70%) patients with clinically uninfected penile prostheses. In some patients more than 1 organism grew and, occasionally, the pump culture was negative but the biofilm was positive. Of 54 patients 49 had positive (90%) culture for staphylococcus genus with 10 different species. All staphylococcal species were sensitive to rifampin and/or tetracycline. We did not find a significant association between prosthesis related pain and culture laboratory results.
Conclusions:
The majority of clinically uninfected penile prostheses have organisms growing in the implant spaces at reoperation. Most of these organisms are staphylococcal species that are sensitive to rifampin/minocycline.
Insights
Revision surgery for penile implants reveals a high rate of bacterial presence, even in uninfected devices. Most bacteria are Staphylococcus species, sensitive to rifampin and minocycline, suggesting potential for antibiotic-coated implants.
Area of Science:
- Urology
- Infectious Disease
- Biomedical Engineering
Background:
- Infection is a significant complication of penile prosthesis implantation, with higher rates during revision surgeries (10-18%) compared to initial procedures (3%).
- The reasons for increased infection risk in revision cases are not fully understood.
- Prosthesis pain is being investigated as a potential indicator of subclinical infection.
Purpose of the Study:
- To investigate the prevalence of bacterial colonization in clinically uninfected penile prostheses during revision surgery.
- To identify the types of bacteria present and their antibiotic sensitivities.
- To assess if prosthesis pain predicts positive bacterial cultures.
Main Methods:
- Prospective study involving cultures from 77 clinically uninfected penile prostheses during revision surgery at three institutions.
- Cultures were obtained from the pump and any visible biofilms.
- Bacterial isolates, particularly Staphylococcus species, were tested for sensitivity to rifampin and tetracycline (minocycline).
Main Results:
- Bacterial growth was detected in 70% (54/77) of clinically uninfected prostheses.
- Staphylococcus species were identified in 90% (49/54) of positive cultures, with 10 different species identified.
- All staphylococcal isolates showed sensitivity to rifampin and/or tetracycline.
- No significant association was found between chronic prosthesis pain and positive culture results.
Conclusions:
- A high percentage of penile prostheses undergoing revision surgery harbor bacteria, even without overt signs of infection.
- Staphylococcus species are the predominant bacteria found and are susceptible to rifampin and minocycline.
- These findings support the use of antibiotic-coated implants to reduce infection risk in revision penile prosthesis surgery.
