Coloplast Titan Inflatable Penile Prosthesis Research Articles

Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

BackgroundModern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. AimTo compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. MethodsWe systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher’s exact and Pearson’s chi-square tests, and logistic regression modeling was performed to account for covariates. OutcomesThe main outcome measures of this study were postoperative infection, explantation, and revision rates. ResultsOf the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates. Clinical ImplicationsVancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and LimitationsData were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. ConclusionThe use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection.Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077–2083.

487 - Effect of antimicrobial dipping solutions on post-operative infection rates in diabetic patients undergoing primary insertion of a Coloplast titan inflatable penile prosthesis

487 - Effect of antimicrobial dipping solutions on post-operative infection rates in diabetic patients undergoing primary insertion of a Coloplast titan inflatable penile prosthesis

105 Impact of Antimicrobial Dipping Solutions on Post-Operative Infection Rates in Diabetic Patients Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

105 Impact of Antimicrobial Dipping Solutions on Post-Operative Infection Rates in Diabetic Patients Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

Clinical Outcomes and Patient Satisfaction After Different Three-Piece Inflatable Penile Prostheses Implantations

Objective: To evaluate the clinical outcomes and patient satisfaction after implantation of either AMS 700 CX inflatable penile prosthesis (IPP) or Coloplast Titan IPP for treatment of erectile dysfunction, and compare the results of these two devices.

066 Prospective Evaluation of Postoperative Penile Rehabilitation: Penile Morphology and Patient Satisfaction 2 Years Following Coloplast Titan Inflatable Penile Prosthesis

066 Prospective Evaluation of Postoperative Penile Rehabilitation: Penile Morphology and Patient Satisfaction 2 Years Following Coloplast Titan Inflatable Penile Prosthesis

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis.

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1–2 h daily for 6–24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

Pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis One-Touch Release Pump

To define and describe a type of pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis (IPP) One-Touch Release (OTR) pump (Coloplast Corp, Minneapolis, MN). We retrospectively reviewed a consecutive series of 550 patients with refractory organic erectile dysfunction who were implanted with a Coloplast Titan IPP with the OTR pump during a period of approximately 4 years. All patients were implanted using standard techniques through an infrapubic or penoscrotal approach. Twenty-nine patients (5.3%) complained that their IPP would not inflate and that the pump bulb felt "hard." Examination revealed that their IPP was working normally; however, the inflate/deflate valve disc had become stuck in the deflate position. Very firm pressure had to be applied to the pump bulb to move the valve disc into the inflate position. Once this was accomplished, the device inflated and deflated normally. Another 14 patients (2.5%) reported this phenomenon to us but were able to apply enough pressure on the pump bulb to rectify it. The inflate/deflate valve disc in the Coloplast Titan OTR pump can occasionally become stuck in the deflate position (7.8% of patients in our experience). Patients may be unable to inflate the device and return for evaluation. In all cases we have encountered, firm pressure on the pump bulb caused the valve to shift into the inflate position, and the device worked properly thereafter. Patients and implanting urologists should be aware of this issue and of the way in which it can be rectified.

Anti‐Infection Dip Suggestions for the Coloplast Titan Inflatable Penile Prosthesis in the Era of the Infection Retardant Coated Implant

Infection is the worst complication seen with inflatable penile prosthesis (IPP). Both the American Medical Systems (AMS) and Coloplast IPP have infection retardant coatings. AMS is coated at the factory with rifampicin and minocycline (InhibiZone). The Coloplast IPP has a hydrophilic coating covalently bonded to its components that will absorb any aqueous solution before implantation and provides increased surface lubricity to decrease bacterial adherence. We tested several antibiotic dips comparing zones of inhibition (ZOI) against five commonly infecting bacteria with coated Coloplast implants. Results were compared with those ZOI created with strips of an AMS IPP precoated with InhibiZone. Pieces of sterile Coloplast Titan IPP were dipped in (i) trimethoprim/polymixin B ophthalmic solution; (ii) trimethoprim/sulfamethoxazole infusion solution; (iii) bacitracin; (iv) rifampicin/minocycline; and (v) rifampin/trimehtoprim/sulfamethoxazole. ZOI for the Titan strips and for AMS InhibiZone coated strips were tested against Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus aureus, Pseudomonas, and Enterococcus. ZOIs of the Coloplast Titan for each of the medicated solutions were compared with ZOI created by undipped strips of a sterile InhibiZone coated IPP placed on plates of the identical bacteria. All dips except bacitracin showed ZOI≥InhibiZone (P≥0.005) for most organisms. Because of broad-spectrum effectiveness, ease of handling, and cost, infusion vial of trimehtoprim/sulfamethoxazole seemed optimal at this time. If trimehtoprim/sulfamethoxazole is unavailable; the ZOI with Polytrim ophthalmic solution zones were almost as good. The Coloplast strips when dipped in several solutions showed equal or significantly larger ZOI against commonly infecting organisms than the InhibiZone coated strips. At the present time using off the shelf trimethoprim sulfamethoxazole infusion solution seems optimum. The flexibility of choosing the drug eluting from the Coloplast device seems promising in the changing bacterial environment.

Coloplast Titan Inflatable Penile Prosthesis with One‐Touch Release Pump: Review of 100 Cases and Comparison with Genesis Pump

In 2008 Coloplast Corporation modified their Titan inflatable penile prosthesis (IPP) with a new One-Touch Release (OTR) pump, in an attempt to facilitate device deflation. There is currently little published data concerning this new pump. The aim of this pilot study was to assess initial patient and physician experience with the Titan OTR pump. Retrospective chart review was used to assess the functionality and surgeon experience with 100 consecutive patients implanted with a Titan OTR pump, compared with 100 prior consecutive patients implanted with a Titan Genesis pump. The ease of implantation of the OTR pump, the number of required postoperative inflate/deflate teaching visits, and OTR pump functionality were assessed and compared with that of the prior Genesis pump. The mean length of follow-up in the Genesis group (N = 100) was 20.8 months, and mean length of follow-up in the OTR group (N = 100) was 8.4 months. There was one device infection in each group. The average number of postoperative teaching sessions needed to teach the patient how to operate the device was 1.87 in the Genesis group, and 1.19 in the OTR group (P < 0.001). The range of teaching visits was 1-5 in the Genesis group, and 1-3 in the OTR group (P < 0.001). No pump malfunctions were seen in either group. Subjectively, the OTR pump was just as easy to implant as the Genesis pump. In addition, the OTR pump was subjectively easier for the surgeon and the patient to deflate, and just as easy to inflate, compared with the Genesis pump. This pilot study revealed that the OTR pump functioned as specified by the manufacturer. With short-term follow-up, no pump malfunctions were detected. The OTR pump was associated with a statistically significant reduction in the number of postoperative teaching sessions required for the patient to properly operate the device. It was subjectively just as easy to implant and inflate, and easier to deflate, compared with the Genesis pump.

ORIGINAL RESEARCH—SURGERY: Cylinder Aneurysm of Parylene‐Coated American Medical System (AMS) 700CX Penile Prosthesis

ABSTRACT Introduction Cylinder aneurysms and leakages are uncommon with three-layered American Medical System (AMS) CX cylinders. Since 2001, an additional parylene coating improves cylinder wear. Aim To report two patients in whom major cylinder aneurysms developed less than 4 years after implantation. Methods Two patients in separate urologic private practices developed significant cylinder aneurysms requiring reoperation. Results Both patients developed aneurysms in 21-cm parylene-coated CX cylinders just short of 4 years of inflatable penile prosthesis (IPP) placement. Both did well after the explantation and insertion of Coloplast Titan IPP (Coloplast; Minneapolis, MN, USA). Conclusion Longer AMS CX IPP cylinders may develop aneurysms more than 3 years after insertion.