(243) Irrisept Washout at the Time of Revision Surgery Decreases Tissue Culture Positivity: Single Center Experience

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Abstract Introduction The presence of biofilm, which resist eradication, at the implant site during inflatable penile (IPP) replacement surgery for infectious or non-infectious reasons appears to increase infection rates. Irrigation at the time of salvage rescue surgery has been shown to work in patients with clinically infected IPPs. Similarly, washout at the time of non-infectious revision surgery has been shown to lower subsequent infection rates. Positive cultures confirm bacterial presence on IPPs in both the clinically infected and uninfected settings. 0.05% chlorhexidine gluconate in sterile water (Irrisept, Irrimax Corporation, Lawrenceville, GA) has been shown to reduce biofilm in the orthopedic literature. Objective We investigated capsule tissue cultures before and after dilute chlorhexidine irrigation in a series of patients who underwent revision surgery. Methods A total of 31 patients with indwelling IPPs underwent revision surgery for both infectious and noninfectious reasons between May 2021 and March 2022. A section of capsule tissue surrounding the pump was sent for culture / gram staining. After implant removal, we performed a washout of all implant spaces with 0.05% chlorhexidine gluconate irrigation (2 bottles of 450mL each). A second tissue culture was obtained post washout. No other additional antibiotic solutions were utilized for irrigation. All patients received clindamycin, gentamicin, and fluconazole for intravenous prophylaxis. Results Of the 31 patients (4 with infection, 27 had noninfectious etiologies), 4 (13%) had evidence of positive bacterial presence prior to washout. All 31 (100%) of these patients had negative cultures after dilute chlorhexidine washout. Conclusions Early results of revision washout with 0.05% chlorhexidine gluconate solution appears to decrease the bacterial load and potentially sterilize the implant capsule at revision surgery of inflatable penile prostheses for both infectious and noninfectious reasons. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Signati, Endo, Pfizer, Irrimax, Procept.