1373 THE IMPACT OF INHIBIZONE® ON ARTIFICIAL URINARY SPHINCTER INFECTION RATE

Abstract

INTRODUCTION AND OBJECTIVES: The artificial urinary sphincter (AUS) has been established as the gold standard for treating male stress urinary incontinence since its introduction in 1972. In April 2008, InhibiZone® (IZ, Minocycline and Rifampin) coated AUS devices were introduced. IZ-coating increased the cost of the device by approximately $1300 per AUS. To date, there is no data to support the assertion that IZ-coating reduces the risk of AUS infection. Therefore, we compared our infection rates before and after the introduction of the IZ-coated AUS, to determine if the added cost of the impregnated device conferred any benefit by reducing AUS infection rates. METHODS: We performed a retrospective review of 426 consecutive patients who underwent AUS implantation by a single surgeon (DSE) from January 2005 through June 2012. The patients were divided equally into two groups: a control group of 213 consecutive male patients who underwent non–IZ AUS implantation (January 2005March 2008) and a study population of 213 consecutive male patients who underwent IZ-coated AUS insertion (April 2008 June 2012). Demographics, comorbidities, previous procedures, and infection rates were compared between the two populations. A cost analysis between the two groups was also performed. RESULTS: Mean age (IZ 71.7, non-IZ 70.9, p 0.103), coronary artery disease (IZ 23% (n 49), non–IZ 16% (n 35), p 0.08) and diabetes mellitus (IZ 19% (n 40), non–IZ 20% (n 42), p 0.81) were comparable between the two groups. The complexity of the AUS cases was similar in the two groups also, with 23% (n 50) of the IZ and 18% (n 38) of the non-IZ group being AUS revision patients (p 0.15). The infection rates in the two groups were identical (IZ 3.3% (n 7), non-IZ 3.3% (n 7), p 0.99). Further, in the more complex subgroup of revision patients, IZ coating did not impact infection rates (IZ 5% (n 2/50), non-IZ 6% (n 3/38), p 0.42). CONCLUSIONS: InhibiZone® impregnation of the AUS did not alter infection rates in our study. The significant added cost of the IZ-coated AUS ( $276,000 more for all 213 IZ-AUS devices) was of no benefit in our series. At our institution, copious antibiotic irrigation has been standard during AUS placement, regardless of the type of device. We feel that the most cost-effective means of avoiding AUS infections is frequent and copious wound and AUS irrigation with antibiotic solution, along with perioperative IV antibiotic therapy. Based on this assessment, we will transition to using non-IZ AUS devices in our practice.