(374) Comparing the Species Richness in Infectious versus Mechanical Failure Cases in Secondary Penile Prostheses Surgeries

Abstract

Abstract Introduction Inflatable penile prosthesis (IPP) is a third-line treatment for treating erectile dysfunction in men. However, complications in the prostheses can cause the patient to undergo secondary penile prostheses (PP) surgery. Infection is a feared complication of IPP surgery and has a higher risk at secondary surgery. Next-generation sequencing (NGS) compares DNA to identify species and report relative abundances. NGS is an established method of microbial detection and identification in Orthopedics, Otolaryngology, wound care, and infectious disease. In prosthetic urology, NGS has been shown to provide better and more acute information than traditional cultures. Objective This study aims to identify species richness (i.e., number of species occurring in a sample) in penile prostheses that needed revision surgery in comparison between infectious etiology and mechanical failure cases. We hypothesize that, during secondary surgery, mechanical failure IPPs will display a greater species richness than infectious caused. Methods This study comprised 126 patients from 2 different centers that underwent revision PP surgery for either infectious or non-infectious issues. Upon entering the pump space (wiped pump/tubing/capsule) during surgery, 2 swabs specimens were collected and sent to the institutional laboratory for routine culture and the other to MicrogenDx for NGS testing. During the specimen evaluation, the species richness of each specimen was recorded and sorted based on the reason for revision PP surgery. ANOVA was used to test effects of ethnicity, age, diabetes status, implant duration, and year of implant removal. Results The demographics of the 126 patients consisted of a median age of 69 (1st quartile= 61, 3rd quartile= 76), of which 84 were White, 41 were African American, and 1 was of unknown ethnicity. 104 patients (83%) needed revision PP surgery due to mechanical failure causes, and 22 patients (17%) needed revision PP surgery due to infectious causes. From the data collected and analyzed, patients who needed revision PP surgery due to mechanical failure showed a larger species richness in the collected biofilm than patients who needed surgery due to infectious reasons (Figure 1; p= 0.04). Conclusions NGS has been shown to accurately represent the characteristics of biofilm present in secondary PP surgery, supported by similar results in Ortho and ENT literature. When the PP was clinically infected, NGS identified less species richness in biofilm from revision PP surgery than non-infectious PP biofilm which is consistent with infections being caused by a few key pathogens per case. Disclosure Yes, this is sponsored by industry/sponsor: MicroGenDX. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: MicroGenDX, Irrisept.