MP25-15 FACTORS ASSOCIATED WITH INFLATABLE PENILE PROSTHESIS (IPP) EXPLANTATION: EVALUATING THE ROLE FOR POSTOPERATIVE ORAL ANTIBIOTICS ADMINISTRATION

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I1 Apr 2017MP25-15 FACTORS ASSOCIATED WITH INFLATABLE PENILE PROSTHESIS (IPP) EXPLANTATION: EVALUATING THE ROLE FOR POSTOPERATIVE ORAL ANTIBIOTICS ADMINISTRATION William R Boysen, Melanie A Adamsky, Andrew J Cohen, Joseph Rodriguez, Sandra Ham, Roger Dmochowski, Sarah F Faris, Gregory T Bales, and Joshua A Cohn William R BoysenWilliam R Boysen More articles by this author , Melanie A AdamskyMelanie A Adamsky More articles by this author , Andrew J CohenAndrew J Cohen More articles by this author , Joseph RodriguezJoseph Rodriguez More articles by this author , Sandra HamSandra Ham More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , Sarah F FarisSarah F Faris More articles by this author , Gregory T BalesGregory T Bales More articles by this author , and Joshua A CohnJoshua A Cohn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.765AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prescribing oral antibiotics following IPP implantation is common practice; however, the impact of oral antibiotics on device infection and explantation is unknown. We sought to identify risk factors associated with device explantation in a prospective national database focusing on the role of outpatient oral antibiotics. METHODS Using MarketScan, we identified men who underwent IPP placement from 2003-2014 and their associated clinical and demographic data. The primary endpoint was subsequent device explantation as determined by IPP removal CPT codes. Multivariate analysis assessed the effect of comorbidity and outpatient oral antibiotics on device explantation. RESULTS 10,847 men underwent IPP placement, with 228 (2.1%) undergoing subsequent explantation at a median of 42 days postoperatively (IQR 27-58). Postoperative oral antibiotics were prescribed following 6528 cases (60.6%). Patients with diabetes, higher Charlson comorbidity index (CCI) and history of prior IPP incurred higher rates of explantation, whereas rates did not differ in men receiving postoperative oral antibiotics (Table 1). On multivariate analysis, diabetes, CCI greater than 2 and prior IPP placement were all associated with increased odds of explantation (p<0.05). Postoperative oral antibiotics did not decrease the odds of explantation and trended towards harm (OR 1.27, 95% CI 0.96-1.68). Among the subset of patients with preoperative intravenous antibiotic data (3008), a regimen consistent with AUA guidelines was administered in 2006 (66.7%). Rate of explantation was lower in patients who received an AUA-recommended antibiotic regimen, although the difference was not significant (1.4 vs 2.3%, p=0.07). However, significantly lower explant rates were experienced by men receiving an aminoglycoside (1.4 vs 2.6%, p=0.04). CONCLUSIONS This review of a prospectively maintained national database did not demonstrate a benefit for postoperative oral antibiotics following IPP. Although this may be related to unmeasured risk factors prompting use of oral antibiotics, it suggests that routine use may be unnecessary and potentially detrimental. In contrast, perioperative intravenous aminoglycoside use is one modifiable factor that may reduce the risk of explantation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e316 Advertisement Copyright & Permissions© 2017MetricsAuthor Information William R Boysen More articles by this author Melanie A Adamsky More articles by this author Andrew J Cohen More articles by this author Joseph Rodriguez More articles by this author Sandra Ham More articles by this author Roger Dmochowski More articles by this author Sarah F Faris More articles by this author Gregory T Bales More articles by this author Joshua A Cohn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...