Prosthesis Procedures Research Articles

Double distal corporal anchoring stitch for lateral penile implant cylinder extrusion.

The ventral and distal aspects of the corpora cavernosa are the thinnest, increasing the likelihood of cylinder extrusion or crossover complications pertaining to inflatable penile prosthesis procedures. A double distal corporal anchoring double stitch can be used to robustly secure impending lateral extrusions and crossovers of implant cylinders. It is a novel, effective corrective measure for the uncommon complication of migrated cylinders in inflatable penile prosthesis placement. To describe the surgical indications and technique for the double distal corporal anchoring fixation stitch for lateral penile implant cylinder extrusion. We discuss a double-stitch technique that is performed following corporoplasty and capsulotomy. A lateral incision is made subcoronally on the affected side to identify the crossover or lateral extrusion. The cylinder is repositioned properly within the native corpora to prevent further cylinder migration. Two 2-0 Ethibond sutures are threaded through the distal cylinder eyelet, and each suture is delivered through the glans with a Keith needle and tied off. An incision is made in the glans, and 1 arm of each suture is tied with the other to create a bridge between the sutures that can be positioned deep within the skin of the glans. Over the past 4 years, 66 patients with lateral cylinder extrusion underwent the double distal corporal anchoring fixation stitch procedure, with overall improved satisfaction (97%). Only 2 patients had surgical complications. One patient experienced repeated lateral extrusion of the penile implant cylinders 6 weeks following the double-anchoring stitches procedure. The second patient developed a painful suture granuloma that necessitated excision, which resolved this issue, and the penile implant cylinder remained in the proper position over a year later. This technique ensures the secure fixation of the affected cylinders in the surgical capsule by creating a bridge between 2 sutures holding each repositioned cylinder in place, and the ensuing fibrotic reaction helps to fixate the extruded cylinder within the midglandular tissue. This surgical technique describes the double distal corporal anchoring stitch for lateral penile implant cylinder extrusion. Further studies are warranted to validate long-term outcomes and satisfaction. The double distal corporal anchoring fixation stitch is a safe and efficacious method to secure cylinders in the proper surgical capsule during revision procedures to correct distal crossovers or laterally extruded penile prosthesis implants.

Society of Urologic Prosthetic Surgeons' Coding and Billing Position Statement on Ancillary/Adjunct Penile Prosthesis Surgical Procedures: Part I

ObjectiveTo create a society position statement on common adjunct penile prosthesis (PP) procedures. While the Medicare Current Procedural Terminology (CPT®) code book lists descriptions of procedures, it is very brief and lacks detail in the small subspecialty of prosthetic urology. At educational/research meetings, wide variation was found in how experts in prosthetic urology code the same procedures, and need for a standardized format in billing common ancillary surgery was voiced. MethodsA subcommittee within the Society of Prosthetic Urologic Surgeons (SUPS) developed a survey assessing coding options for several procedures commonly adjunct to PP placement, which was distributed in the fall of 2022. The results of the survey were used to develop consensus statements on coding adjunct PP procedures; statements were distributed among society membership and meetings for approval. ResultsThirty members replied to the survey; demographics were obtained as follows: 73% were trained in a fellowship, 50% identified as university/academic practitioners, and 50% in community/private practice; and 63% respondents place more than 50 implants annually. Only 1 of the 30 respondents stated confidence in coding for these ancillary procedures. Specifically, differences in how to code curvature correction procedures were observed throughout the survey results. ConclusionsOnly 1 in 30 prosthetic urologists expressed confidence in coding and billing of adjunct PP procedures, further confirming the need for a society position statement. Therefore, we generated a consensus society position statement on common surgeries that are adjunct to PP placement.

Modified Technique to Rehabilitate American Society of Anesthesiology-III Patient, Through Flapless Procedure With Computed Tomography-Guided Surgery.

The aim was to evaluate the safety and effectiveness of a computed tomography-guided surgery implant placement with a flapless technique and immediate functional loading in an American Society of Anesthesiology-III patient. This technical note involved a 64-year-old American Society of Anesthesiology-III patient. Her hopeless teeth were extracted and a restorative evaluation was provided as a prosthetic reference. The surgical procedure was based on the flapless technique that let us to use local anesthesia. The authors used an All-on-4 concept restoration for maxilla and conventional fixed prosthesis procedures for jaw rehabilitation. The authors placed 4 tilted implants in the upper maxilla and 6 right implants in the jaw. Implants were loaded with a provisional prosthesis on the same day of surgery. Five months later, provisional restoration was removed; the authors placed into the ceramic crowns 2 Procera Implant Bridge (Nobel Biocare) frameworks, developed through computer-aided design/computer-aided manufacturing technology. Computed tomography-guided surgery is a minimally invasive technique that allows, through a flapless approach, safer and more predictable procedures. In this technical note, the authors achieved accurate implant placement and precise fit of restoration with natural looking appearance; this patient-oriented-treatment led to a reduced healing time with better compliance.

Evisceration with implantation of an intrascleral silicone prosthesis in dogs: A retrospective study of 107 cases (2010-2019).

To retrospectively analyze the preoperative clinical characteristics and surgical outcomes of evisceration with implantation of an intrascleral silicone prosthesis (EIISP) procedures in dogs and evaluate whether brachycephalic dogs are more prone than non-brachycephalic dogs to develop postoperative complications after EIISP. Ninety-One dogs (19 of which were brachycephalic) were included. Medical records from 2010 to 2019 were reviewed. Signalment, reason for EIISP, postoperative complications, follow-up time, and postoperative eye appearance were analyzed. The most frequently represented breeds were French Bulldog [11/91 (12%) dogs], Jack Russell Terrier [6/91 (7%)], and Shih Tzu [6/91 (7%)]. Brachycephalic dogs were statistically younger than non-brachycephalic dogs at the time of EIISP (p = 1.61 × 10-5 ). Uncontrolled glaucoma was the most common reason for EIISP in both groups. Short-term complications (from D0 to D15) seen in 7/91 (8%) dogs included epithelial corneal ulcers (n = 3), keratoconjunctivitis sicca (KCS) (n = 2), and prosthesis extrusion (n = 2). Long-term complications seen in 26/91 (29%) dogs included KCS (n = 11), epithelial corneal ulcers (n = 7), stromal ulcers (n = 3), entropion (n = 4), and prosthesis extrusion (n = 1). Extrusion of the prosthesis occurred twice in eyes that had undergone diode laser transscleral cyclophotocoagulation. The risk of postoperative complications was not significantly different between brachycephalic and non-brachycephalic dogs (p = .3). Brachycephalic status in dogs does not appear to influence the risk of complications from EIISP. Nevertheless, the present study is a reminder that EIISP focuses on esthetics, and considering the possible complications associated with it, it does not provide a benefit to the patient compared to enucleation.

Air microbial sampling in operating theatres by active and passive methods: equation correlation from the GISIO-ISChIA study results and comparison with the EU GGMP recommendation, towards the definition of threshold values.

The aim of this study was to calculate the equation of correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA), by using the data from the ISChIA study, and to compare the values obtained with the recommended limits defined by the EU Guidelines to Good Manufacturing Practice (EU GGMP), 2008, for clean areas used to manufacture sterile medicinal products. Air sampling was performed during 335 elective prosthesis procedures. Correlation between CFU/m3 and IMA values was evaluated using the Spearman test; p<0.05 was considered to indicate significance. This equation was used to calculate the IMA values corresponding to the CFU/m3 recommended threshold values by EU GGMP for the different Grades of microbial contamination. The following correlation equation was obtained: y = 1.86 + 0.12x, where "x" = cfu/m3 value and "y" = IMA value. The relationships between CFU/m3 and IMA values obtained from active and passive sampling during the ISChIA study showed to be in line to those suggested by the EU GGMP for pharmaceutical manufacturing for Grade C and D. This study shows that the EU GGMP relationship could be considered valid also for operating theatres. Both methods, active and passive samplings, can be used to evaluate microbial air quality and highlight critical situations; however, in particular during the activity, passive sampling estimating the risk posed by airborne microorganisms to the surgical wound, can be considered more relevant, and for its simplicity, economy and standardization, can be suggested for routine microbial monitoring.

Applying the standardized infection ratio for reporting surgical site infections in Australian healthcare facilities.

We explored the utility of the standardized infection ratio (SIR) for surgical site infection (SSI) reporting in an Australian jurisdiction. Retrospective chart review. Statewide SSI surveillance data from 2013 to 2019. Individuals who had cardiac bypass surgery (CABG), colorectal surgery (COLO), cesarean section (CSEC), hip prosthesis (HPRO), or knee prosthesis (KPRO) procedures. The SIR was calculated by dividing the number of observed infections by the number of predicted infections as determined using the National Healthcare Safety Network procedure-specific risk models. In line with a minimum precision criterion, an SIR was not calculated if the number of predicted infections was <1. A SIR >0 (≥1 observed SSI, predicted number of SSI ≥1, no missing covariates) could be calculated for a median of 89.3% of reporting quarters for CABG, 75.0% for COLO, 69.0% for CSEC, 0% for HPRO, and 7.1% for KPRO. In total, 80.6% of the reporting quarters, when the SIR was not calculated, were due to no observed infections or predicted infections <1, and 19.4% were due to missing covariates alone. Within hospitals, the median percentage of quarters during which zero infections were observed was 8.9% for CABG, 20.0% for COLO, 25.4% for CSEC, 67.3% for HPRO, and 71.4% for KPRO. Calculating an SIR for SSIs is challenging for hospitals in our regional network, primarily because of low event numbers and many facilities with predicted infections <1. Our SSI reporting will continue to use risk-indexed rates, in tandem with SIR values when predicted number of SSI ≥1.

The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study

Aim: In this study, we aim to investigate the effect of dual anti-platelet agents on osseointegration by studying a sample of rats with titanium implants in their tibias. &#x0D; Material and Method: The titanium implants were placed surgically to the left tibias of a sample group of 50 rats. After implantation, the rats were randomly divided into five groups: acetylsalicylic acid (ASA) (n =10), treated with 20 mg/kg of ASA; ASA+ clopidogrel (CLPD) (n=10), treated with 20 mg/kg of ASA and 30 mg/kg of CLPD; ASA+ prasugrel (PRSG) (n=10), treated with 20 mg/kg of ASA and 15 mg/kg of PRSG; ASA+ ticagrelor (TCGR) (n=10), treated with 20 mg/kg of ASA and 300 mg/kg of TCGR; and a control group (CNT) (n =10) received no further treatment following implant surgery. The experimental period lasted four weeks, during which all medications were administered with oral gavage. Concluding the experimental period, the animals were euthanized, and researchers collected blood serums and the implants, along with some surrounding bones, from each rats. &#x0D; Results: Bone implant connection and bone filling ratios (%) were observed histologically and documented. The bone-implant connection and bone filling ratios of the rats do not show statistically significant differences between the groups examined (P&gt;0.05). &#x0D; Conclusion: In this study, it was shown that there was no bone healing problem between the antiaggregant given groups and between these groups and the control group. Too many people have to take single or double antiaggregant due to many diseases. We think that it is an important study in terms of knowing that bone healing will not be negatively affected when dental implants or other bone prosthesis procedures are applied to these patients. The results of this study should be supported by further research.

Feasibility and outcomes of the removable prosthesis in medically compromised patients

Increasing awareness about providing the necessary care of oral health is essential for patients with a removable prosthesis. The awareness is less interested in dental disorders, being busier with the systemic ones. Planning prosthetic management should only be done after a thorough evaluation of the underlying systemic conditions because the treatment plan might vary accordingly. Previous studies have demonstrated that many systemic diseases are associated with removable prosthesis (RP) procedures. We aim to discuss the feasibility and outcomes of the removable prosthesis for medically compromised patients, including many conditions as diabetes mellitus, cardiovascular, renal, hematological, pulmonary, gastrointestinal disorders and immunocompromised patients. Taking adequate care of oral hygiene practices is recommended for these patients. In addition, it is necessary to have frequent care, but short follow-up visits to make sure that the modalities are still valid for additional use, and to investigate for potential complications and adverse events. Adequate prophylaxis against some diseases might also be the only convenient solution. Therefore, proper management of the medical condition might be associated with the enhanced success of the modality with favorable outcomes and better quality of life. Making unified protocols to deal with these patients is also suggested to enhance the practice among the different clinical settings.

UK practice for penile prosthesis surgery: baseline analysis of the British Association of Urological Surgeons (BAUS) Penile Prosthesis Audit.

To undertake a prospective multicentre national audit of penile prosthesis practice in the UK over a 3-year period. Data were submitted by urological surgeons as part of the British Association of Urological Surgeons Penile Prosthesis National Audit. Patients receiving a penile prosthesis (inflatable or malleable) were included as part of a prospective registry over a 3-year period. Data were validated and then analysed using a software package (Tableau). A total of 1071 penile prosthesis procedures were included from 22 centres. The three commonest aetiological factors for erectile dysfunction were diabetes, prostate surgery and Peyronie's disease. Of the recorded data, inflatable penile prostheses were the commonest devices implanted, with 665 devices used (62.1%), whereas malleable prostheses accounted for 14.2% of the implants. Recorded intra-operative complications included urethral injury (0.7%, n = 7), corporal perforation (1.1%, n = 12) and cross-over (0.6%, n = 6). Known postoperative complications were recorded in 9.8% of patients (74/752), with the two most frequently reported being postoperative penile pain (n = 11) and scrotal haematoma (n = 14). This baseline analysis is the largest prospective registry of penile prostheses procedures to date. The data show that, over the 3-year collection period in the UK, there are now fewer surgeons performing the procedure, together with a reduction in the number of centres. Peri-operative complications were infrequent, and the rate of implant abortion (e.g. as a result of urethral injury) was very low. Further follow-up data will be required to publish long-term outcomes and patient satisfaction.

Management of Mandibular Molar Having Sub-Gingival Caries by Root Amputation: A Case Report

Conservative management of a tooth has always been the primary option for a dental clinician in themanagement of severely decayed teeth. Therefore instead of going for the extraction or elaborate andexpensive treatment such as implant-supported prosthesis procedures like root amputation/resection andhemisection can be opted to salvage these compromised teeth for longer period of functioning. Rootamputation is a procedure of removing the root portion of the multirooted tooth that has been affected withsubgingival caries, periapical pathology, or any other defects. This article describes a case report of rootamputation in mandibular molars.

A Modified Surgical Technique for Reservoir Placement During Inflatable Penile Prosthesis Implantation.

IntroductionAt the moment, there is an ongoing debate regarding the controversial issue of the ideal reservoir placement (RP) surgical technique during implantation of a 3-piece inflatable penile prosthesis, but a definitive winner has not yet emerged.AimIn this light, we herein describe our modified technique for RP into the space of Retzius through the external oblique muscle fascia and present its results.MethodsIn total, 253 inflatable penile prosthesis procedures (110 AMS 700 and 143 Coloplast Titan) via a single transverse penoscrotal incision were retrospectively reviewed. 2 Kocher-Langenbeck retractors were placed over the right side of the penoscrotal incision and were used to retract the incision superior to the pubic bone. Then, the external oblique muscle fascia was incised medially to the spermatic cord which was retracted laterally. Next, a “W”, Vicryl 1, stay suture was placed to the incision, and under direct visualization, external oblique muscle fibers were dissected and fascia transversalis was perforated using a Metzenbaum scissor. A Foerster lung grasping clamp was then used to dissect further into the extraperitoneal space and create the reservoir space. The reservoir was placed into the created space and fascia incision was closed using the prepositioned stay suture. The procedure was then completed in a standard fashion.OutcomesThe main outcome measures were intraoperative or postoperative complications of our modified RP technique.ResultsAll 253 patients were available for short-term follow-up (average 9.1 months, range 3–22 months). No intraoperative or postoperative complications were reported. Reservoir-related prolonged pain (1 month) was reported by 1 patient, resolving completely after treatment with non-steroidal analgesics.ConclusionWe are, surely, not proposing that our modified RP technique should supplant all other methods; rather, it should be considered another useful option for RP in the implanter’s armamentarium.Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inatable Penile Prosthesis Implantation. Sex Med 2020;8:378–382.

The Role of Organizational Factors and Human Resources in the Provision of Dental Prosthesis in Primary Dental Care in Brazil.

This study aimed to investigate factors associated with dental prosthesis procedures by oral health teams (OHTs) in the Brazilian primary health care in 2013–2014, who participated in the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB). This is an analytical cross-sectional study using a questionnaire with dichotomous questions applied in 18,114 OHTs. The dependent variable studied was making any type of prosthesis (removable or fixed). Independent variables involved issues related to human resources and health service management. Data were submitted to simple and multiple binary logistic regression with odds ratio calculation, 95% confidence intervals, and p-values. Most OHTs (57%) do not perform any dental prosthesis. The teams that are more likely to perform dental prostheses have human resources-related characteristics, such as professionals admitted through public examinations (OR 1.25, 95% CI 1.14–1.36) and those involved in permanent education (OR 1.13, 95% CI 1.02–1.26). Moreover, OHTs with a more organized work process and that receive more significant support from municipal management are more likely to perform dental prostheses (p < 0.05). The oral health teams which tended to provide the most dental prostheses to benefit patients were; hired as civil servants, had a municipal career plan, involved all members of the oral health team, and trained undergraduate dental students from outreach programs. Better organizational support and improved work incentives may be needed to get the majority of oral health teams to start providing dental prostheses to their patients.

What Has Changed in the Dental Prosthesis Procedures in Primary Health Care In Brazil?

The study aimed to identify the changes in the provision of dental prosthetics procedures in the Brazilian primary care. Secondary data from the Brazilian "National Programme for Improving Access and Quality of Primary Care" was assessed and three similar questions related to dental prostheses execution that were answered by the same 9,698 oral health teams, in 2011/2012 and 2013/2014, were compared. There was a 4.3% increase in the number of teams that identified individuals with prosthetic needs; a 0.8% increase in the number of teams that performed impression for prosthetic purposes; and the number of teams that reported performing dental prostheses consultations increased by 0.6%. Overall, there was a small modification in the number of teams that provided dental prosthesis procedures in Brazil.

Indications for Penile Prosthesis Revision: Lessons Learned to Limit Technical Causes of Reoperation

IntroductionReoperations are necessary in approximately 30% of penile prostheses over 15 years following original implantation. AimTo determine the most common indications for initial penile prosthesis reoperation at our institution and to describe technical alterations that have improved postoperative outcomes. MethodsA retrospective review of all patients who underwent penile prosthesis reoperation surgery at a single, high-volume Canadian center between 2006 and 2018 was performed. Patient demographic information, prosthetic device factors, and surgical complications were analyzed. Main Outcome MeasureThe primary outcomes were the indications for and variables associated with initial penile prosthesis reoperation. ResultsDuring the study period, 99 first-time penile prosthesis reoperations were performed out of 1,161 penile prosthesis procedures (Figure 1). This included 14 (14.1%) explants, 32 (32.3%) revisions, and 53 (53.5%) explant and reimplants. Indications for reoperation included 49 (49.5%) mechanical failures, 28 (28.3%) technical causes (such as correction of malposition or device herniation), and 12 (12.1%) procedures to treat chronic postoperative pain. Median follow-up was 78.5 months, and median time to reoperation was 46 months. Mechanical failures commonly occurred in the tubing (n = 13, 26.5%) and cylinders (n = 13, 26.5%). The most frequently repositioned component was the valve pump (n = 11, 39.3%). Infection-related indications for reoperation were uncommon (n = 10, 10.1%). Clinical ImplicationsMore than a quarter of penile prosthesis reoperations may have been preventable with alterations in surgical technique, device positioning, and postoperative care. Strengths and LimitationsThis study evaluates a range of indications for initial penile prosthesis reoperation performed by a high-volume single surgeon over a 12-year period. Limitations include the retrospective nature of the study, loss of patients to follow-up, and lack of etiological determinants of prosthesis failure. ConclusionsReoperation for device repositioning and herniation was required for more than a quarter of the initial penile prosthesis implants. Modifications in surgical technique and perioperative care can help reduce the incidence of these technical causes for reoperation.Chan EP, Punjani N, Campbell JD, et al. Indications for Penile Prosthesis Revision: Lessons Learned to Limit Technical Causes of Reoperation. J Sex Med 2019; 16:1444–1450.

Acute low back pain among registered nurses. Organizational implications for practice management.

To date there is a lack of evidence about the impact of shiftwork on the occurrence of acute low back pain among registered nurses working non-traditional shifts, including nights and 12-hour shifts. The objectives of the present study were: 1) to investigate the impact of shiftwork, physical activity and body mass index on the occurrence of acute low back pain among female shift-registered nurses; 2) to suggest preventive interventions. The author conducted a cross-sectional nested case-control analysis of data concerning acute low back pain and staffing data for female registered nurses employed in hospital wards. The analysis found a relationship between acute low back pain and nightshift, extended shifts, obesity; the adoption of forward rotating schedules proved to be effective in minimizing the frequency of acute low back pain. The findings showed that the prevention of acute low back pain should consider interventions aimed at minimizing not only physical ergonomic factors, but also organizational risks and lifestyle factors.

Availability of Dental Prosthesis Procedures in Brazilian Primary Health Care.

Objectives To describe dental prosthesis provision in the Brazilian public health service and report the performance of dental prosthesis procedures according to the Brazilian macroregions. Methods A structured interview was conducted with senior-level health professionals from each of the 18,114 oral health teams (OHT). The dependent variables were performance of removable prostheses and prosthesis procedures, including provision of fixed prostheses by OHT. Descriptive statistics were produced together with performing a cluster analysis using SPSS version 19.0. Results The manufacture of any type of prosthesis was done by a minority of OHT (43%). The most commonly provided types of dental prosthesis were removable full and partial dentures. Cluster 1 (teams that performed prosthesis procedures the most) was composed of a smaller number of teams (n = 5,531), and Cluster 2 (composed of teams that do not perform prosthetics or that perform them in small amounts) consisted of 12,583 teams. The geographic distribution of clusters reveals that the largest proportion of Cluster 1 teams is located in the Northeast (33.9%) and Southeast (33.6%). Conclusions A minority of OHT produce dental prostheses. There is an unequal geographical distribution of clusters.

Factors influencing clinical consistency and variability in voice prosthesis management

Purpose: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability.Method: A national survey was completed by SLP’s from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site.Result: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice.Conclusion: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.

Irrigation and Debridement for Periprosthetic Hip Infection: Does Timing Play a Role?

AbstractPeriprosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty (TJA). The rate of PJIs in total hip arthroplasty (THA) procedures varies from 0.3 to 2.9%. Irrigation and debridement (I&amp;D) with modular implant exchange is often performed to treat PJIs. Early management of infection is cited to offer a higher success rate. The goal of this study was to examine the outcomes of early I&amp;D for THA PJIs. We reviewed 38 patients diagnosed with a PJI between 2009 and 2014 who went on to have I&amp;D with modular implant exchange. Patients were separated into three cohorts based on time from index procedure (≤4, 4–8, and ≥8 weeks), and were subsequently linked to treatment success and failure. Success was defined as the eradication of infection and resolution of presenting symptoms. All patients who required additional procedures due to infection were considered failures. Twenty-eight patients (73.7%) were successfully treated while 10 patients (26.3%) required further surgical interventions for persistent infection. Overall, average time between THA and I&amp;D was 44.4 days. Successful I&amp;Ds on average occurred within 41.9 days of the index procedure; while unsuccessful I&amp;Ds were performed 51.6 days after index THA. Additionally, our study demonstrated that obese patients were more likely to fail debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) procedures (p = 0.006). While our results demonstrate that the average time to I&amp;D with a modular exchange was shorter for those who had a successful outcome, the difference was not significant (p = 0.37).

204 Fibrillar™ (Oxidized Regenerated Cellulose) Reduces the Risk of Postoperative Hematoma Following Inflatable Penile Prosthesis

Fibrillar™, oxidized regenerated cellulose, is a plant-based topical absorbable hemostatic agent that was first introduced in the 1960s and is widely used today in many surgical fields. This study aimed to determine the effect of Fibrillar™ on postoperative drain output and subsequent complications following inflatable penile prosthesis (IPP) procedures. Starting in March 2016, a practice change occurred at our institution for procedures involving IPPs by a single surgeon. Fibrillar™ pledgets began to be included in corporotomy closure. The Fibrillar™ group was compared to a control group without Fibrillar™ dating back to December 2015. Demographic, intraoperative, and postoperative parameters including cumulative postoperative drain output were evaluated for cases with and without Fibrillar™. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with Fisher's exact test. A total of 41 men underwent IPP procedures. Median drain output was significantly lower when Fibrillar™ was utilized: 35 mL vs 65 mL (p=0.03). Fibrillar™ was used in 8/41 cases (20%). Median age, BMI, operative time, and total device cylinder length did not differ significantly between the two groups. The distribution of medical comorbidities, etiology of ED, race, and procedure type was similar in the two groups. There were 2 subsequent IPP explantations in this cohort of patients with both occurring in the group without Fibrillar™. Both patients had multiple co-morbidities and one explantation was directly related to hematoma formation. There were no confounding variables identified that were predictive of drain output.

Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study.

Surgical Site Infection (SSI) is one of the major complications following insertion of hip or knee prosthesis. The aim of the present study was to describe rates of SSIs and associated risk factors during hip and knee prosthesis procedures in Italian hospitals. Italian hospitals were invited to join the ISChIA (Surgical Site Infections in Arthroplasty Surgery) project and participated in the study on a voluntary basis. SSI surveillance was performed according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) -SSI protocol. The study population consisted of all patients who had a prosthetic knee or hip joint replacement between March 2010 and February 2011. Only elective operations were include. A total of 14 hospitals and 1285 surgical procedures were included. SSI cumulative incidence was 1.3 per 100 hip and 2.4 per 100 knee surgical procedures; a significant positive trend of SSI incidences was observed with increasing SSI risk index. In multivariate analysis, considering hip procedures, the single independent risk factor associated to SSI was operation length (RR: 4.54; 95%CI: 1.06-19.48). For knee procedures, no significant risk factor was identified. In the present study, SSI cumulative incidence was in the range of European data. However, a larger number of operations is needed to better estimate SSI rates. A second edition of the ISChIA project has been already conducted and results of the two surveys will provide new insight to further our knowledge for infection control.