Inflatable Penile Prosthesis Revision Surgery Research Articles

(419) In Vivo Next Generation Sequencing Identifies More Isolates vs. Standard Culture During Revision Inflatable Penile Prosthesis Insertion: A Single Center Experience

Abstract Introduction The presence of biofilm at the inflatable penile prosthesis (IPP) component sites, which resists eradication, likely increases postoperative infection rates in revision surgery. The microbiome of (IPP) revision surgery has been shown to be increasingly complex and the weak microbe Staph epidermidis is no longer prevailing and was previously considered the major causative agent for overt infections. Furthermore, next generation sequencing (MicrogenDx, Lubbock, TX, USA) has been used recently to demonstrate that in certain scenarios such as mechanical malfunction, erosion, and infection, specific microbes dominate. Due to the disastrous complications with postoperative IPP infection, it is paramount to provide additional evidence for increased utilization of next generation sequencing over traditional cultures during IPP revision surgery. This will serve to guide postoperative treatment if necessary. Objective We investigated a cohort of IPP revision patients receiving intraoperative low concentration chlorhexidine (CHG) lavage to see whether next generation sequencing or traditional cultures of the pump space reveals more isolates. Methods A total of 31 patients with indwelling IPPs underwent revision surgery for both infectious and noninfectious reasons between May 2021 and March 2022 by a single, high volume implant surgeon who solely uses 0.05% CHG dip and irrigation. Once the pump capsule was entered, swabs were taken from the pump space and sent for traditional culture and next generation sequencing. All cultures were obtained prior to irrigation with 0.05% chlorhexidine (CHG) solution (Irrimax corporation, Lawrenceville, GA, USA). All patients received perioperative clindamycin, gentamicin, and fluconazole. Results 1 patient was excluded due to missing next generation sequencing results. Of the 30 remaining patients, 4 presented with infectious and 26 with noninfectious etiologies. 93% (28/30) patients had negative traditional cultures prior to irrigation with 0.05% CHG; however, 21% (6/28) of these patients had isolates on next generation sequencing. Only 7% (2/30) had positive preop irrigation cultures and isolates on next generation sequencing. Both of these patients presented with infection. 1 of these patients had a concordant next generation sequencing result. However, the other patient had multiple isolates. The traditional culture showed only pseudomonas a. On NGS, it was the third most abundant on NGS at only 4% compared to the most and second most abundant being E. coli at 83% and Klebsiella p. at 12%. Conclusions These results suggests that a greater number of isolates are obtained using next generation sequencing compared to traditional cultures during IPP revision surgery. Consequently, this may lead to better prevention and/or better guide treatment of postoperative IPP infection in the setting of IPP replacement. Although, further studies are needed prior to universally adopting this modality. Disclosure Yes, this is sponsored by industry/sponsor: MicrogenDx. Clarification Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: MicrogenDx.

MP62-11 IRRISEPT WASHOUT AT THE TIME OF REVISION SURGERY DECREASES TISSUE CULTURE POSITIVITY: SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP62-11 IRRISEPT WASHOUT AT THE TIME OF REVISION SURGERY DECREASES TISSUE CULTURE POSITIVITY: SINGLE CENTER EXPERIENCE Alex Fuselier, Chris Smith, Ryan Griggs, Paul H. Chung, Ed Karpman, and Gerard Henry Alex FuselierAlex Fuselier More articles by this author , Chris SmithChris Smith More articles by this author , Ryan GriggsRyan Griggs More articles by this author , Paul H. ChungPaul H. Chung More articles by this author , Ed KarpmanEd Karpman More articles by this author , and Gerard HenryGerard Henry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The presence of biofilm, which resists eradication, at the implant site during inflatable penile prosthesis (IPP) replacement surgery for infectious or non-infectious reasons appears to increase infection rates. Irrigation at the time of salvage rescue surgery has been shown to work in patients with clinically infected IPPs. Similarly, washout at the time of non-infectious revision surgery has been shown to lower subsequent infection rates. Positive cultures confirm bacterial presence on IPPs in both the clinically infected and uninfected settings. 0.05% chlorhexidine gluconate (CHG) in sterile water (Irrisept, Irrimax Corporation, Lawrenceville, GA) has been shown to reduce biofilm in the orthopedic literature. More recently, it has been shown to be highly efficacious against IPP bacteria such as E. coli and Pseudomonas that now predominate eroded and infected devices. We investigated capsule tissue cultures before and after dilute chlorhexidine irrigation in a series of patients who underwent revision surgery. METHODS: A total of 44 patients with indwelling IPPs underwent revision surgery for both infectious and noninfectious reasons between May 2021 and September 2022. A section of capsule tissue surrounding the pump sent for culture & gram staining. After implant removal, we performed a washout of all implant spaces with 0.05% chlorhexidine gluconate irrigation, 900cc for noninfectious reasons and 1800cc for infectious reasons. A second tissue culture was obtained adjacent to the prior sample post washout. No other additional antibiotic solutions were utilized for irrigation. All patients received clindamycin, gentamicin, and fluconazole for intravenous prophylaxis. RESULTS: Of the 44 patients, 4 (10%) were with infectious / erosion reasons, 40 (90%) had noninfectious etiologies. 6 (14%) of the 44 patients had evidence of positive bacterial presence prior to washout. 4 of the 4 (100%) patients for infectious / erosion reasons and 2 of the 40 (5%) of the noninfectious etiologies had evidence of bacterial presence prior to washout. All 44 (100%) of these patients had negative cultures after dilute chlorhexidine washout. CONCLUSIONS: Early results of revision washout with 0.05% chlorhexidine gluconate in sterile water solution appears to decrease the bacterial load and potentially sterilize the implant capsule at revision surgery of inflatable penile prostheses for both infectious and noninfectious reasons. Consequently, this may lead to future reduction in postoperative infection rates after IPP revision surgery. Source of Funding: Coloplast © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e865 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Fuselier More articles by this author Chris Smith More articles by this author Ryan Griggs More articles by this author Paul H. Chung More articles by this author Ed Karpman More articles by this author Gerard Henry More articles by this author Expand All Advertisement PDF downloadLoading ...

160 Three-Piece Inflatable Penile Prosthesis Revision Surgery Leads to Increased Implant Size Independent of Revision Indication

160 Three-Piece Inflatable Penile Prosthesis Revision Surgery Leads to Increased Implant Size Independent of Revision Indication

336 Reservoir Induced Bladder Rupture: A Rare Complication of Inflatable Penile Prosthesis Revision Surgery

Bladder rupture is a rare complication following prosthesis component replacement for malfunction. Current practice for a deflated reservoir involves overdistention of the reservoir during revision surgery, which can increase the risk of this complication. There is limited literature describing this complication or providing recommendations regarding intraoperative or postoperative management. Our objective is to describe our experiences with this rare complication and propose ways to manage and possibly avoid this complication. We retrospectively reviewed the charts of two patients who underwent inflatable penile prosthesis (IPP) revision surgery complicated by bladder rupture. Intraoperatively, the existing reservoirs had been left in situ and overdistended to break the surrounding fibrous capsule according to common practice prior to being placed in circuit with new cylinders and pump. Gross hematuria was noted in each case following this technique. Delayed identification of the complication occurred in the first case, while the complication was immediately recognized in the second case. The first patient returned to the OR for complete penile prosthesis removal and replacement of component parts including placement of an ectopic reservoir and foley catheter. He subsequently underwent bladder closure for a persistent bladder leak. The second patient underwent immediate removal of three-piece penile prosthesis and placement of a malleable prosthesis and foley catheter. Follow-up cystogram demonstrated the bladder had completely healed with conservative management alone. On follow-up, both patients were satisfied with their penile prostheses and able to engage in penetrative intercourse. Immediate intervention following identification of this complication was crucial to the successful outcomes. In retrospect, this complication may have been minimized if the reservoirs were refilled, but not overdistended. Any back pressure may signify the fibrous capsule has become too thickened and may perforate the bladder if broken. Alternative reservoir placement or placement of a malleable prosthesis may be safer options in this scenario.

Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories.

Inflatable penile prosthesis (IPP) is the gold standard for medically refractory erectile dysfunction. Infectious complications remain a significant concern in IPP revision surgery. We sought to evaluate the impact of number of IPP surgeries on subsequent infection rates. A retrospective analysis was performed on all new patients (self or outside provider referred) presenting for consideration of IPP revision or salvage surgery between 2013 and 2015. Histories were reviewed including number of prior IPPs, reason for evaluation, and rate, number, and timing of prior IPP infections. No patients were operated on by the primary investigator prior to data acquisition. We identified 44 patients with at least one prior IPP presenting for consultation regarding IPP revision/salvage. There were 88 IPPs placed by 28 different surgeons. In patients with two or more devices, 55% had at least two different surgeons. The most common reason for presentation was malfunction (52%). The risk of specific device infection was strongly correlated and increased based on number of prior IPPs: 1st (6.8%; 3/44), 2nd (18.2%; 4/22), 3rd (33.3%; 4/12), 4th (50%; 4/8), and 5th (100%; 2/2) (R2 = 0.90, p = 0.01). Similarly, overall rates of infection positively correlated with number of prior IPP-related surgeries performed (R2 = 0.97, p < 0.01). The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPP-related surgeries. The majority of patients referred for penile implant surgery can expect to have experienced at least one infection by their 4th device. These data represent a change in paradigm on revision prosthetic surgery.

027 Single-center, 7-year Experience of Inflatable Penile Prosthesis Revision Surgery

Inflatable Penile Prosthesis (IPP) remains the mainstay for surgical management of erectile dysfunction (ED). Complications such as malfunction, infection and erosion oftentimes require explanation of the prosthesis. The primary aim was to determine the feasibility and efficacy profile of performing revision IPP operations. A single-center, retrospective review of all patients who underwent IPP re-implantation from 2008-2015 were included in our analysis. Age, BMI, original surgery date, etiology of explantation, and re-implantation surgical variables including operative duration, blood loss, hospital duration, and date of activation were recorded for each patient. Feasibility and efficacy were determined by comparing blood loss, hospital duration and date of activation to patients undergoing primary implantation. 57 patients with a mean age and BMI of 68 years and 29.3, respectively, underwent revision IPP placement between 2008 and 2015. 15% (9/57) of patients had a prior history of multiple (>2) IPP surgeries prior to revision surgery at our institution. The date of original implantation ranged from 1977 to 2014. The most common reason for revision was IPP malfunction (pump, reservoir or tubing leak, etc.) at 82.5% followed by infection at 12.3%, exchange from semi-rigid to three-piece IPP at 3.6%, and erosion at 1.8%. Revision surgery resulted in an average blood loss of 44.9, operative duration of 130.2 minutes, and hospital duration of 1.1 days. Time to activation of IPP was approximately 52.7 days.

Safety of the “Drain and Retain” Option for Defunctionalized Urologic Prosthetic Balloons and Reservoirs During Artificial Urinary Sphincter and Inflatable Penile Prosthesis Revision Surgery: 5-Year Experience

To present our 5-year experience using a "drain and retain" option, in which existing urologic prosthetic balloons and reservoirs (UPBR) were emptied but not removed during routine artificial urinary sphincter (AUS)/inflatable penile prosthesis (IPP) reoperation. All genitourinary prosthetic surgeries by a single surgeon from July 2007 to September 2012 were reviewed. Patients were included in the study group if they underwent prosthetic replacement (with contralateral new UPBR placement) or subtotal device removal, although having their original UPBR drained and retained. Virgin cases, complete device removals for gross infection, and revision cases using the original UPBR were excluded. The "drain and retain" technique involved defunctionalizing the existing UPBR by aspirating all its fluid, placing the tubing on traction, and cutting proximally. Postoperative outcomes with specific attention to infection were reviewed and compared with patients receiving their first prosthesis (control group). A total of 551 urologic prostheses (251 AUS and 300 IPP) were inserted in 433 men during the 5-year study period. Among 120 reoperative prosthetic cases, UPBR were drained and retained in 55 (46%). The control group consisted of 352 patients undergoing initial AUS (154 cases) and/or IPP (236 cases) placement. No difference in infection rate was identified between the control group (6 of 390; 1.5%) and the "drain and retain" group (1 of 55; 1.8%; chi-square = 0.024; P = .88). Retention of defunctionalized uninfected genitourinary prosthetic balloons and reservoirs does not increase complication rate during reoperative AUS and/or IPP surgery.

Continuing Medical Education: A Case of Mechanical Failure with Proximal Perforation at the Time of Revision Surgery (CME)

ABSTRACT Background Implantation of inflatable penile prosthesis (IPP) is a well-established treatment for medically refractory erectile dysfunction with proven long-term reliability. However, if an IPP fails, the subsequent surgery to fix the IPP can be more difficult with higher risks of complications than the primary implantation. Aims To review and evaluate a case of a difficult IPP replacement surgery for ways to improve surgical techniques and outcomes. Materials &amp; Methods Perform a case report of a difficult IPP replacement surgery in which the patient had proximal perforation of the tunica albuginea with a review of the pertinent literature. Results The rear tip sling is a successful way to repair proximal perforation of the tunica albuginea. Recent publications show new surgical techniques to lower infection rates in IPP revision surgery. Discussion The rear tip sling appears to have better outcomes than a synthetic windsock for repairs of proximal perforation of the tunica albuginea. Recent publications have shown that the revision washout decreases penile prosthesis infection rates in revision surgeries. Conclusion While revision surgery for IPPs have higher risks than primary implantation, newer surgical techniques are helping to reduce these risks.