INFECTION RETARDANT COATED VERSUS NON-COATED PENILE PROSTHESIS CULTURES DURING REVISION SURGERY: A MULTICENTER STUDY

Abstract

INTRODUCTION AND OBJECTIVES: Previously published papers have shown that the majority of clinically uninfected penile prostheses have organisms growing in the implant spaces at reoperation (J Urol 172: 153, 2004). Virtually all 3-piece penile prostheses (IPP) placed in the United States have infection retardant coatings; InhibiZone on the American Medical Systems 700 series and Titan hydrophilic coating on the Coloplast Titan series. These coated penile prostheses appear to reduce infection rates by close to half in published studies in primary implantation. However, these infection retardant coated prostheses have not been shown to reduce revision/ replacement infection rates without the addition of a revision washout (J Urol 173: 89, 2005). This is the first investigation of whether these infection retardant coated implants have lower cultures rates at the time of clinically uninfected revision surgery as compared to penile prostheses without coating. METHODS: At four institutions, cultures were prospectively obtained from penile prostheses at revision surgery for any reason, between November 2000 and July 2012. Immediately upon surgical exposure of the pump, cultures were obtained. If a bacterial biofilm was noted on any component, it was additionally cultured. 258 patients had cultures taken at the time of revision surgery for any reason, only patients undergoing clinically uninfected revision/replacement surgeries with adequate data were included for a total cohort of 194 patients: 67 with infection retardant coated implants and 127 uncoated penile prostheses. RESULTS: During revision surgery for non-infected IPP, culture positive bacteria was found in 93 of 127 (67%) patients with non coated IPP. Meanwhile, 40 of 67 (60%), of patients with coated IPPs showed positive cultures. Of the 93 non-coated patients, 81 (87%) had positive culture for Staphylococcus genus, while 30 (75%) of the 40 patients with coated IPP had a cultured isolate of the Staphylococcus genus. CONCLUSIONS: Positive cultures and visible bacterial biofilm have been shown to be present on clinically uninfected IPPs at the time of revision surgery in the majority of patients whether or not the IPP is coated with infection retardant coating.