Skip to main content

Advertisement

Log in

Minimizing Penile Implant Infection: A Literature Review of Patient and Surgical Factors

  • Men’s Health (R Carrion and C Yang, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Inflatable penile prosthesis (IPP) is an effective treatment for erectile dysfunction in patients’ refractory to oral or injectable treatment. While the rate of infection has decreased over the past decade, it is still the most feared complication of IPP placement. Here, we assemble possible patient and surgical factors attributing to the risk of infection. Studies have been gathered addressing each of these factors, and an Oxford Level of Evidence is assigned to each recommendation based on strength of the study. The goal of this review is to inform surgeons of possible risks in order to further reduce the risk of infection and thus increase success of IPP placement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lindeborg L et al. Satisfaction and complications with the Titan(R) one-touch release penile implant. Scand J Urol. 2014;48(1):105–9.

    Article  CAS  PubMed  Google Scholar 

  2. Bettocchi C et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J Sex Med. 2010;7(1 Pt 1):304–9.

    Article  PubMed  Google Scholar 

  3. Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group. J Urol. 2000;164(2):376–80.

    Article  CAS  PubMed  Google Scholar 

  4. Henry GD, Wilson SK. Updates in inflatable penile prostheses. Urol Clin North Am. 2007;34(4):535–47. vi.

    Article  PubMed  Google Scholar 

  5. Montague DK. Periprosthetic infections. J Urol. 1987;138(1):68–9.

    CAS  PubMed  Google Scholar 

  6. Chlebicki MP et al. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control. 2013;41(2):167–73.

    Article  CAS  PubMed  Google Scholar 

  7. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2012;9:Cd004985.

    PubMed  Google Scholar 

  8. Darouiche RO et al. North American consensus document on infection of penile prostheses. Urology. 2013;82(4):937–42.

    Article  PubMed  Google Scholar 

  9. Turan A et al. Smoking and perioperative outcomes. Anesthesiology. 2011;114(4):837–46.

    Article  PubMed  Google Scholar 

  10. 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(4):373–83.

    Article  PubMed  Google Scholar 

  11. Kigera JW et al. Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis. PLoS One. 2012;7(8):e42254.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Silverstein A, et al. Nasal carriage of Staphylococcus aureus as a potential risk factor for infection after penile prosthesis placement. Int J Impot Res. 2002;14(S61).

  13. Berthelot P 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(4):373–82.

    Article  CAS  PubMed  Google Scholar 

  14. Bode LGM et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010;362(1):9–17.

    Article  CAS  PubMed  Google Scholar 

  15. Henry GD et al. Penile prosthesis cultures during revision surgery: a multicenter study. J Urol. 2004;172(1):153–6.

    Article  PubMed  Google Scholar 

  16. Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996;156(2 Pt 1):402–4.

    Article  CAS  PubMed  Google Scholar 

  17. Wilson SK, Delk 2nd JR. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995;153(3 Pt 1):659–61.

    CAS  PubMed  Google Scholar 

  18. Wilson SK et al. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology. 2007;70(2):337–40.

    Article  PubMed  Google Scholar 

  19. Thomalla JV et al. Infectious complications of penile prosthetic implants. J Urol. 1987;138(1):65–7.

    CAS  PubMed  Google Scholar 

  20. McManus LM et al. Agonist-dependent failure of neutrophil function in diabetes correlates with extent of hyperglycemia. J Leukoc Biol. 2001;70(3):395–404.

    CAS  PubMed  Google Scholar 

  21. Barbul AED. In: Brunicardi ADF, Billiar T, Dunn D, Hunter J, Mathews J, Pollock R, editors. Wound Healing, in Schwartz's Principles of Surgery. Chicago: McGraw Hill Medical; 2010. p. 209–33.

    Google Scholar 

  22. Mulcahy JJ, Carson Iii CC. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60(1):167–72.

    Article  PubMed  Google Scholar 

  23. Garber BB, Marcus SM. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology. 1998;52(2):291–3.

    Article  CAS  PubMed  Google Scholar 

  24. Wilson SK et al. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol. 1998;159(5):1537–9. discussion 1539–40.

    Article  CAS  PubMed  Google Scholar 

  25. Bishop JR et al. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992;147(2):386–8.

    CAS  PubMed  Google Scholar 

  26. Goldstein I et al. Radiation-associated impotence. a clinical study of its mechanism. JAMA. 1984;251(7):903–10.

    Article  CAS  PubMed  Google Scholar 

  27. Dubocq FM et al. Outcome analysis of penile implant surgery after external beam radiation for prostate cancer. J Urol. 1997;158(5):1787–90.

    Article  CAS  PubMed  Google Scholar 

  28. Biering-Sorensen F, Sonksen J. Sexual function in spinal cord lesioned men. Spinal Cord. 2001;39(9):455–70.

    Article  CAS  PubMed  Google Scholar 

  29. Collins KP, Hackler RH. Complications of penile prostheses in the spinal cord injury population. J Urol. 1988;140(5):984–5.

    CAS  PubMed  Google Scholar 

  30. Radomski SB, Herschorn S. Risk factors associated with penile prosthesis infection. J Urol. 1992;147(2):383–5.

    CAS  PubMed  Google Scholar 

  31. Tobian AA, Gray RH, Quinn TC. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision. Arch Pediatr Adolesc Med. 2010;164(1):78–84.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Sidi AA et al. Penile prosthesis surgery in the treatment of impotence in the immunosuppressed man. J Urol. 1987;137(4):681–2.

    CAS  PubMed  Google Scholar 

  33. Ginaldi L et al. The immune system in the elderly: II. Specific cellular immunity. Immunol Res. 1999;20(2):109–15.

    Article  CAS  PubMed  Google Scholar 

  34. Chung E et al. Clinical outcomes and patient satisfaction rates among elderly male aged >/=75 years with inflatable penile prosthesis implant for medically refractory erectile dysfunction. World J Urol. 2014;32(1):173–7.

    Article  PubMed  Google Scholar 

  35. Gonzalez Chiappe S, et al. Use of clean intermittent self-catheterization in France: A survey of patient and GP perspectives. Neurourol Urodyn. 2015.

  36. Edokpolo LU, Stavris KB, Foster HE. Intermittent catheterization and recurrent urinary tract infection in spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18(2):187–92.

    Article  PubMed  Google Scholar 

  37. Diokno AC, Sonda LP. Compatibility of genitourinary prostheses and intermittent self-catheterization. J Urol. 1981;125(5):659–60.

    CAS  PubMed  Google Scholar 

  38. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011(11):Cd004122.

  39. Darouiche RO et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26.

    Article  CAS  PubMed  Google Scholar 

  40. 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 Thail. 2009;92(7):898–902.

    Google Scholar 

  41. Parienti JJ et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA. 2002;288(6):722–7.

    Article  PubMed  Google Scholar 

  42. Weber WP et al. Surgical hand antisepsis with alcohol-based hand rub: comparison of effectiveness after 1.5 and 3 minutes of application. Infect Control Hosp Epidemiol. 2009;30(5):420–6.

    Article  PubMed  Google Scholar 

  43. Mandava SH et al. Infection retardant coated inflatable penile prostheses decrease the incidence of infection: a systematic review and meta-analysis. J Urol. 2012;188(5):1855–60.

    Article  PubMed  Google Scholar 

  44. Yerdel MA et al. Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial. Ann Surg. 2001;233(1):26–33.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Boxma H et al. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet. 1996;347(9009):1133–7.

    Article  CAS  PubMed  Google Scholar 

  46. Wolf Jr JS et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90.

    Article  PubMed  Google Scholar 

  47. Sadeghi-Nejad H 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(6):535–8.

    Article  CAS  PubMed  Google Scholar 

  48. Eid JF et al. Coated implants and "no touch" surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%. Urology. 2012;79(6):1310–5.

    Article  PubMed  Google Scholar 

  49. Cahill PJ et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2014;96(16):1333–9.

    Article  PubMed  Google Scholar 

  50. Sgroi MD et al. Experience matters more than specialty for carotid stenting outcomes. J Vasc Surg. 2015;61(4):933–8.

    Article  PubMed  Google Scholar 

  51. LaPar DJ et al. Mitral valve repair rates correlate with surgeon and institutional experience. J Thorac Cardiovasc Surg. 2014;148(3):995–1003. discussion 1003–4.

    Article  PubMed  Google Scholar 

  52. Henry GD et al. Centers of excellence concept and penile prostheses: an outcome analysis. J Urol. 2009;181(3):1264–8.

    Article  PubMed  Google Scholar 

  53. Graf K et al. Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program. Interact Cardiovasc Thorac Surg. 2009;9(2):282–6.

    Article  PubMed  Google Scholar 

  54. Stulberg JJ et al. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA. 2010;303(24):2479–85.

    Article  CAS  PubMed  Google Scholar 

  55. Katz BF et al. Use of a preoperative checklist reduces risk of penile prosthesis infection. J Urol. 2014;192(1):130–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tobias Kohler.

Ethics declarations

Conflict of Interest

Bradley Holland declares no potential conflicts of interest.

Tobias Kohler reports grants and personal fees from AMS and Coloplast.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Men’s Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holland, B., Kohler, T. Minimizing Penile Implant Infection: A Literature Review of Patient and Surgical Factors. Curr Urol Rep 16, 81 (2015). https://doi.org/10.1007/s11934-015-0554-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-015-0554-2

Keywords

Navigation