The Urethral Microbiome During Inflatable Penile Prosthesis Placement

Abstract

ABSTRACT Introduction Foley catheter placement prior to inflatable penile prosthesis (IPP) implantation permits drainage of the bladder to ensure safe retropubic reservoir placement and allows for palpation of the urethra to prevent inadvertent injury. The urethra is often colonized with commensal organisms mostly concentrated at the meatus and fossa navicularis to which the Foley catheter is exposed during placement. Following placement, the catheter remains on the sterile field during surgery. Objective We sought to investigate if the microbiome of the urethra could contaminate the Foley catheter during IPP placement. Methods Data was retrospectively reviewed on all patients who underwent three-piece IPP placement at a single institution from 2/2020 to 6/2021. Patient demographics, clinical characteristics, and comorbidities were recorded. Culture swabs from the fossa navicularis and exposed Foley catheter were collected intra-operatively after Foley catheter placement. Growth of aerobic, anaerobic, and fungal organisms was assessed. Univariate analyses with chi-square tests were performed to compare baseline demographic and clinical data with isolation of organisms from culture swabs. Results A total of 50 patients were included in this study. All surgeries were performed via penoscrotal approach by a single surgeon. 22% (n = 11) were revision procedures, all of which were due to mechanical device malfunction. The median age of our cohort was 66.5 years (range: 42-78 years) and 30% (n = 15) had a BMI of 30 kg/m² or greater. Three patients (6%) were current smokers and 46% (n = 23) were diabetic. Two patients (4%) had isolation of aerobic organisms and five patients (10%) had isolation of anaerobic organisms. No patients had isolation of fungal organisms. There was no statistically significant relationship between obese BMI, diabetes diagnosis, or current smoking and the isolation of organisms. Three patients (6%) ultimately developed a device infection; notably, none of these patients had isolation of organisms from their culture swabs at initial implant. Conclusions A number of patients had isolation of aerobic and anaerobic organisms from their intra-operatively collected urethral swabs, but none of these patients have currently shown evidence of a device infection. This is the first study to examine the urethral microbiome and its potential effect on Foley catheter contamination at the time of IPP placement. Further study is needed to determine if this could be a significant source of device infection. Disclosure No