Biofilm and Penile Prosthesis Infections in the Era of Coated Implants: A Review

Abstract

The numbers of inflatable penile prosthesis (IPP) implanted has increased yearly due to the large numbers of patients treated for prostate cancer, patients becoming refractory to the five phosphodiesterase inhibitors and Peyronie's disease. Prosthesis implantation can be associated with a variety of complications with device infection being the most dreaded one. An understanding of the pathogenesis of these infections is necessary to allow the surgeon to plan treatment. Infection begins with colonization of planktonic bacteria in the implant space. Biofilm forms around the bacterial mass within 48 hours. Bacteria in biofilm have reduced growth rates, may change phenotypically, and develop resistance to drugs. Antibiotics and the body's macrophages will kill the planktonic bacteria released from the biofilm but never eliminate the infecting organisms. This review will delineate present thinking on infection prevention and biofilm's role in device infection. IPP infection before and after the coated implants will be characterized. Future ideas for prevention and treatment of infection will be explored. The coated implants have reduced the incidence of IPP infections. The bacteria that cause the majority of infections in the era of the coated implant seem to have changed from predominantly nosocomial coagulase-negative Staphylococcus to more virulent organisms. Device infection requires new paradigms of prevention and treatment strategy because the infecting bacteria are different and the patients are sicker. The problem of infection is considerably decreased with coated IPP, yet those infections that do occur are systemic in nature and seem to be caused by more aggressive organisms. These infections are not usually amenable to salvage because the virulence of the bacteria. Future research to prevent these infections must be directed to magnifying the effective dosage of antibiotics to penetrate the biofilm or eliminating the bacteria's ability to secrete the slime.