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Tips and tricks in the management of inflatable penile prosthesis infection: A review
Scott C Brimley1, Ayad Yousif1, Joseph Kim1
1Department of Urology, Tulane University, New Orleans, LA, USA.
Objective:
To review the management of inflatable penile prosthesis (IPP) infection.Methods: The 'gold-standard' treatment for medication-refractory erectile dysfunction is the IPP, wherein the most dreaded complication is infection. To prevent and manage an infected IPP requires a strict protocol during the pre-, intra-, and postoperative course. A variety of techniques and antibiotics are used in conjunction with IPP implantation to prevent contamination. This modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review of the literature examines the current practices by leading urologists in the management of IPP infection, as well as provides insights for improved patient outcomes.
Results:
: Patient selection is important to reduce IPP infections, and those with risk factors need to be optimised prior to surgery. Proper antibiotic prophylaxis includes pre-, intra-, and postoperative administration. As most infections derive from normal skin flora, every measure must be taken to sterilise the skin and avoid direct device skin contact. Up to 3% of virgin IPPs develop infections and this number increases to 18% in revision cases. Antibiotic coverage depends on the presenting microbe, which can vary significantly between patients.
Conclusions:
: A greater success in IPP implantation can be attributed to appropriate prophylaxis, field sterilisation, and surgical technique. For those implants that do become infected, often erectile function can be preserved by immediate antibiotic coverage combined with salvage procedures.
Insights
Preventing and managing inflatable penile prosthesis (IPP) infections requires strict protocols. Early antibiotic coverage and salvage procedures can preserve erectile function in infected cases.
Area of Science:
- Urology
- Infectious Disease
- Surgical Innovation
Background:
- Inflatable penile prosthesis (IPP) is the gold standard for medication-refractory erectile dysfunction.
- Infection is the most feared complication following IPP implantation.
- Preventing and managing IPP infections necessitates rigorous pre-, intra-, and postoperative protocols.
Purpose of the Study:
- To review current management strategies for inflatable penile prosthesis infections.
- To examine techniques and antibiotic protocols for preventing and treating IPP infections.
- To provide insights for improving patient outcomes in IPP implantation.
Main Methods:
- Modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) literature review.
- Analysis of current practices by leading urologists in IPP infection management.
- Examination of preventative measures including antibiotic prophylaxis and surgical field sterilization.
Main Results:
- Patient selection and optimization of risk factors are crucial for reducing IPP infections.
- Comprehensive antibiotic prophylaxis (pre-, intra-, and postoperative) is essential.
- Skin sterilization and minimizing device-skin contact are vital due to common skin flora origins of infection.
- Infection rates are approximately 3% for virgin implants and 18% for revision cases.
- Antibiotic coverage must be tailored to the specific causative microbe.
Conclusions:
- Successful IPP implantation relies on appropriate prophylaxis, sterile surgical fields, and meticulous technique.
- Infected implants may allow for preservation of erectile function through prompt antibiotic therapy and salvage procedures.
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