Coloplast Titan Research Articles

To drain or not to drain an inflatable penile prosthesis implantation? A multi-institutional experience tracking scrotal hematoma and infection occurrence

ABSTRACT Introduction Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection. Objectives We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration for drainage. Methods Our subjects underwent IPP implantation by three European high volume surgeons. All implantations were performed via the penoscrotal access using the Coloplast Titan Touch device. Only patients without a previous penile implantation were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics accordingly to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days. Results There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free. Conclusion Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast).

Evaluation of Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis

BackgroundDelayed infection, thought to be due to gradual biofilm formation, remains a feared complication after inflatable penile prosthesis (IPP) insertion. Understanding and preventing biofilm formation is necessary to prevent infections. AimTo develop an in vitro model and compare growth of biofilm by different bacteria on IPPs and evaluate the anti-infective efficacy of the Coloplast Titan and AMS 700 InhibiZone. MethodsSterile IPPs (Coloplast) were cut into rings and incubated with S. epidermidis, S. aureus, P. aeruginosa, A. baumannii, or K. pneumoniae cultures in tryptic soy broth (TSB) (4 hour) to ensure adequate bacteria attachment, and then in only TSB (120 hours) to allow for biofilm formation. Rings were fixed with ethanol and biofilm measured by spectrophotometer (OD570) after crystal violet staining. This methodology was repeated for S. epidermidis and P. aeruginosa with Coloplast rings dipped in 10 ml of a 10 mg/ml Rifampin, 1 mg/ml Gentamicin, and deionized water solution and undipped AMS InhibiZone rings. Crystal violet assay (OD570) was repeated after incubation within bacteria (2 hour), and then only TSB (120 hours). OutcomesThe primary outcome of the study was OD570 readings, indirectly measuring biofilm mass on implant rings. ResultsS. epidermidis, S. aureus, A. baumannii, P. aeruginosa, and K. pneumoniae all formed significant biofilm. P. aeruginosa showed the strongest predilection to grow biofilm on IPPs. P. aeruginosa also formed significant biofilm on antibiotic-treated Coloplast and AMS rings, while S. epidermidis was inhibited. No significant difference was found in biofilm inhibition between the implants. Clinical TranslationOur findings suggest gram-negative bacteria may form biofilm more proficiently and quickly on IPPs than gram-positive organisms. Commonly used antibiotic treatments on IPPs may be effective against S. epidermidis but not against P. aeruginosa biofilm formation. Strengths & LimitationsThis is the first study comparing biofilm formation by different bacteria organisms on IPPs and the inhibitive ability of Coloplast and AMS implants against biofilm formation. Clinical data on organisms responsible for infected IPPs is needed to determine the clinical relevance of our findings. ConclusionOur novel in vitro model of biofilm formation of IPPs evaluated the effect of a gentamicin/rifampin antibiotic dip on Coloplast Titan implants and the anti-infective capacity of the minocycline/rifampin precoated AMS 700 InhibiZone against S. epidermidis and P. aeruginosa. P. aeruginosa was able to grow on both antibiotic-treated implants, with no significant difference, and should continue to be a specific target of investigation to reduce delayed post-operative IPP infections.Narasimman M, Ory J, Bartra SS, et al. Evaluation of Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis. J Sex Med 2022;19:1024–1031.

Boston Scientific vs. Coloplast: A Prospective Analysis of a Single High-volume Surgeon's Inflatable Penile Prosthesis Experience

ABSTRACT Introduction Surgical implantation of a penile prosthesis may be offered to patients with erectile dysfunction (ED) as primary treatment or after failed therapy. The two FDA approved three-piece inflatable penile prostheses (IPPs) on the market, the AMS (American Medical Systems) 700TM series (Boston Scientific, Massachusetts) and the Coloplast Titan® (Coloplast, Minnesota), differ in their overall design and anti-microbial coating. However, little is known as to whether these differences have an impact on risk of infection or revision. Objective To compare the likelihood of infection and short-term revision in IPP placements performed by a single high-volume surgeon when using Boston Scientific's AMS 700TM series versus Coloplast Titan® implants. Methods We performed a prospective analysis of a single IPP surgeon's experience with AMS 700TM and Titan® at two private hospitals between January 2017 and December 2019. The surgeon alternated the implants every other week for comparison. Data was collected on patient demographics, implant characteristics, case duration, and complications. Results A total of 542 patients (mean age 69.2 years) underwent 548 IPP implantations during the two-year period. Of the 548 cases, 303 (55.3%) implantations were performed using Boston Scientific AMS 700TM while 245 (44.7%) were with Coloplast Titan®. Only one (0.18%) case was complicated by post-operative infection despite drain placement for three days in all 548 cases. This infection occurred in a Coloplast Titan® placed as a revision for SST deformity. Seven (1.3%) cases ultimately required revision by the time of review. Although five of the seven cases requiring revision were done using AMS 700TM implants, this did not amount to a statistically significant increase in risk compared to Titan® (p=0.39). First revisions of AMS 700TM were noted to be done earlier than Titan® on average (225 days vs. 450 days postoperatively, p=0.42). Overall, the most common reason for revision was tube fracture (n=3). Diabetes, case time, performing hospital, reservoir type, and reservoir location were not significant prognostic factors for revision (p>0.05). Conclusions Risk of infection or short-term revision is not impacted by whether the IPP is manufactured by Coloplast or Boston Scientific. A high-volume IPP surgeon has a significantly decreased risk of infection and revision compared to those currently published in the literature. Disclosure No

Evaluation of Gram Positive and Gram Negative Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis

ABSTRACT Introduction Infection is the most feared complication of inflatable penile prosthesis (IPP), often necessitating complete removal. Late infection after IPP insertion is thought to be due to the slow formation of a biofilm. Understanding and preventing biofilm formation would be a breakthrough in preventing IPP infections. Objective We aimed to develop an in vitro model to compare formation and growth of biofilms on penile implants by bacteria commonly associated with infection. Methods Sterile IPPs (Coloplast Titan) were cut into rings and incubated with S. epidermidis, S. aureus, P. aeruginosa, or K. pneumoniae cultures in tryptic soy broth (TSB) for a 4 h attachment period, and then in only TSB for 120 h. We utilized a published and validated method to measure biofilm mass. Rings were then dipped in deionized water to wash off additional bacteria and either fixed with ethanol (EtOH) or not treated further (no fix). Fixing was employed to preserve biofilm on the rings that otherwise may have been lost during crystal violet staining. Biofilm formation was measured with a spectrophotometer (OD570) after crystal violet staining. Results All bacteria formed substantial biofilm on implant rings as measured by OD570. As expected, the gram-negative bacteria, P. aeruginosa and K. pneumoniae produced significantly more biofilm than the gram-positive S. epidermidis and S. aureus. Interestingly, P. aeruginosa formed the most biofilm by at least a factor of 6 in both testing conditions. The ethanol fixing condition produced more consistent results for the crystal violet assay. Conclusions Our novel in vitro model of biofilm formation of penile implants can be used in future studies to evaluate the effect of different antibiotic dips and anti-infective capacity of pre-coated implants against different bacteria. Our findings suggest gram-negative bacteria form faster and a greater quantity of biofilm on penile implants as compared to gram-positives. P. aeruginosa displayed the strongest predilection to form biofilm on implants compared to all other bacteria studied, and could be investigated as a specific target to reduce delayed post-operative IPP infections. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific

Current Practices in High and Low Volume Centers Regarding Corporotomy Localization During Penoscrotal Inflatable Penile Implant Surgery

ABSTRACT Introduction Literature concerning corporotomy location in multi-component inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not non-existent. However, corporotomy location represents an important issue that may influence immediate and long-term outcomes regarding patient and partner satisfaction as well as device durability. Objective To report practices in low- and high-volume penile implant centers regarding corporotomy location. Methods Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Additionally, patient characteristics, indication for penile implant, operative time, type of implant utilized, reservoir characteristics and short term complications were reported. Results 809 virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 +/- 9.6 years old. In total, 299 AMS 700TM (Boston Scientific) and 510 Coloplast Titan® devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 +/- 0.29. A statistically significant correlation between lower proximal /distal measurement ratio and higher age (p=0.0013), lower BMI (p<0.0001), use of rear tip extenders (RTE) (p=0.04), lower RTE length (p<0.0001) and absence of diabetes (p=0.0004) was reported. In a 3-month follow up period 49 complications and 37 revision procedures were reported. Conclusions This is the first study reporting and evaluating the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design limits the study outcomes. Even in experienced hands proximal length measurement in relation to distal length measurement in penoscrotal IPP surgery is in many cases sub-optimal, particularly when the tubing-cylinder connection of each device is taken into account. Disclosure No

Patient Perception of Penile Size and Device after Penile Implant Revision for Mechanical Failure

ABSTRACT Introduction IPP revision after implant malfunction yields rare insight into patient preference and perception of penile implant variations in brand and size. Objective To assess patients’ perception of their penile implant after IPP revision. Methods Retrospective review of all patients undergoing revision surgery for purely mechanical malfunction (fluid leak) at our institution since 2017. Patients with greater than 6 months follow-up after revision were contacted to comment on changes in penile size and device preference. Patients were asked 1. “Did you notice any change in penile length or girth after your last surgery, explain, and 2. “Please describe your preference (if any) of implant and why”. We utilize the Coloplast Titan with “classic” (genesis) pump in most cases, with AMS Cx cylinders being used in cases with attenuated corpora (aneurysm). Results 21 patients were identified that met criteria with an average age of 70. 15/21 were successfully contacted. 9 Coloplast, 2 Mentor, and 12 AMS devices (Cx =7, LGX =4, Ultrex =1) were revised. Device brand used to replace the broken IPP was n= 19 for Coloplast and n=3 for AMS (Cx =2, Lgx =1). Mean and median time to revision was 9 years overall (2-26) and was similar between Coloplast and AMS. Fluid leak location showed no discernable pattern. Total average implant length increased 2.2 cm from 20.6 cm to 22.8 cm. 8/10 patients were reached that had had both AMS and Coloplast devices (all AMS initially). 12 patients stayed within the manufacturer. Despite change in implanted length, most patients did not discern a definitive change in penile length unless cylinders increased by > 3 cm (perhaps reflecting under-sizing of initial implant). All patients correctly described improvement or no change in penile girth when compared to actual cylinder sizes. Patients preferred Coloplast (6 – girth/erection quality/pump), AMS (1 pump/flaccidity) and undecided (1). Several patients felt consistently cycling the device after revision led to relative length improvement and ease of use. Conclusions Our small cohort of IPP revision patients for mechanical failure reveals that revision often requires longer cylinders but this is often imperceptible to the patient. Increased cylinder girth was a key factor in driving device preference. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast

A0548 - Trends of utilization and comparison between AMS® vs. Coloplast Titan® Inflatable Penile Prostheses (IPPs) in Italy – results from a national registry (INSIST-ED)

A0548 - Trends of utilization and comparison between AMS® vs. Coloplast Titan® Inflatable Penile Prostheses (IPPs) in Italy – results from a national registry (INSIST-ED)

Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study.

Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.

Technological Advances in Penile Implant Surgery

BackgroundDuring the last century, surgical management of erectile dysfunction has evolved from an experimental concept to a core treatment modality with widespread use among the men's health community. Over time, innovations in materials, mechanical design elements, device coatings, and surgical technique have provided patients with low-risk, reliable, and reproducible erectile function with high satisfaction rates. AimTo provide a foundation for future innovation by improving understanding of historical penile prosthetics and the rationale behind incremental technological improvements for the contemporary Men's Health physician. MethodsLiterature review was conducted to generate a comprehensive review of historical technological innovations in penile implant surgery. Companies with FDA approved penile prosthetics in use in the United States were contacted for information regarding technological innovations in the past and future devices in development. A separate literature review was performed to identify any significant future device design elements being tested, even in the ex vivo setting, which may have future clinical applications. OutcomesTechnological innovations in penile implant surgery were described. ResultsCurrent options for the prosthetic surgeon include malleable penile prostheses (MPP), self-contained (2-piece) inflatable penile prostheses, and multicomponent (3-piece) inflatable penile prostheses. Current MPPs consist of a synthetic coated solid core which allow for manipulation of the penis for concealability while maintaining sufficient axial rigidity to achieve penetration when desired. Multi-component (3-Piece) IPPs currently include the Coloplast Titan and Boston Scientific/AMS 700 which consist of a fluid reservoir, intrascrotal pump, and intracavernosal cylinders. The devices have undergone numerous design updates to the cylinders, pump, reservoir, tubing, and external coatings to increase reliability and decrease short- and long-term complications. Clinical ImplicationsFuture innovations in penile prosthetic surgery seek to broaden the indications and applicability to the transgender community and improve both safety and functionality for patient and partner. Strengths & LimitationsThe review is limited primarily to penile prosthetics approved for current or historical clinical use in the United States and may not be representative of the global prosthetic environment. Additionally, the research and development of future innovations, particularly those provided by device manufacturers, is likely limited by non-disclosure to maintain a competitive advantage. ConclusionsPenile prosthetic surgery will undoubtedly remain integral to the treatment of erectile dysfunction, and education regarding the current state of technological innovation will empower the prosthetic surgeon and biomedical engineering community to improve contemporary patient care and drive the development of the next generation of implantable penile prosthetics.Barnard JT, Cakir OO, Ralph D, et al. Technological Advances in Penile Implant Surgery. J Sex Med 2021;18:1158–1166.

Do Antifungals and Local Anesthetic Affect the Efficacy of Antibiotic Dipping Solution?

The rates of infection after inflatable penile prosthesis (IPP) range from 1% to 3%; however, with changes in antibiotic practice intraoperatively and the incorporation of local anesthetic dips, it is unclear whether this incidence of infection is affected. To evaluate whether the utilization of local anesthetic dips and antifungal solutions affect the efficacy of previously established dips across multiple species and strains. Strains of four different species of bacteria and one fungus were prepared in a standardized confluency. A standardized, and sterile protocol was used to punch out 6mm circular discs from the reservoir of a Coloplast Titan device. The discs were submerged in a standardized concentration of antimicrobials (combinations of Bactrim, Rifampin+Gentamicin, Vancomycin, Zosyn, and Amphotericin B) and plated. The zone of inhibition (ZOI) was measured at 24, 48, and 72 hours. Five repetitions of each organism was performed (>1700 discs), and the mean ZOI was calculated. Saline and DMSO were used as control on each plate. Main outcome was the ZOI identified with each antibiotic solution, and the secondary outcome was the efficacy of the antibiotic over the course of 72 hours. Difference in antibiotic efficacy was seen when each bacterial species was evaluated separately, with rifampin and gentamicin having less efficacy towards all organisms other than S. epidermidis. When looking specifically at the Candida species, amphotericin B was significantly better than other antibiotic solutions. In regards to efficacy of antibiotics over 72 hours, all treatment groups showed a decrease in ZOI over time. However, treatment groups that included rifampin demonstrated the ability to inhibit S. aureus and S. epidermidis over the 72-hour period. To improve clinical practice and alleviate concerns that incorporation of local anesthetic and antifungals may decrease the efficacy of antibiotic solutions. A major strength of the study is that it is the most robust and scientifically sound study performed on this topic with approximately 1700 repetitions. It is also the first study of its kind to include a wide spectrum of bacterial and fungal strains and antibiotic solutions along with temporal data on drug elution over a 72-hour period. A limitation of the study is the in vitro model, and this needs to be validated in a clinical setting. Dipping prosthetics in antifungal and local anesthetic does not decrease the efficacy of the antimicrobials. The drug elution capabilities of the hydrophilic coating lasts primarily for 24-48hours. Mishra K, Bukavina L, Long L, etal. Do Antifungals and Local Anesthetic Affect the Efficacy of Antibiotic Dipping Solution?. J Sex Med 2021;18:966-973.

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study.

Literature concerning corporotomy location in multicomponent inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not nonexistent. Aim of our study was to report practices in low-, moderate-, and high-volume penile implant centers regarding corporotomy location and evaluate its potential impact on intraoperative and short-term postoperative complications. Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Eight hundred and nine virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 ± 9.6 years old. In total, 299 AMS 700™ (Boston Scientific, USA) and 510 Coloplast Titan® (Minneapolis, MN USA) devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 ± 0.29 while no statistical difference was found among low-, moderate-, and high-volume penile implant centers. A statistically significant correlation between lower proximal/distal measurement ratio and higher age (p = 0.0013), lower BMI (p < 0.0001), lower use of rear tip extenders (RTE) (p = 0.04), lower RTE length (p < 0.0001), and absence of diabetes (p = 0.0004) was reported. In a 3-month follow up period, 49 complications and 37 revision procedures were reported. This is the first study reporting the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design and the short follow up period limits the study outcomes. Corporotomy location during penoscrotal IPP implantation does not correlate with intraoperative or short-term postoperative complication rates. Future studies with longer follow up are needed in order to evaluate the association of corporotomy location with long-term complications.

Survie et facteurs associes à la durée de vie des prothèses péniennes a long terme

Implantation of penile prosthesis is constantly growing but little long-term data is available concerning the associated factors of prosthesis survival. Our aim was to describe the long-term survival of penile prostheses and to identify factors influencing long-term prosthesis survival. This is a retrospective, monocentric cohort of patients who underwent their first implantation of a penile prosthesis, between May 2000 and March 2017, at the Reims University Hospital. Prosthesis survival was calculated by the Kaplan-Meier method. A univariate and multivariate analysis to estimate the risk of surgical removal/revision of the prosthesis was performed using a Cox model. 150 patients were included, and 61 patients underwent surgical removal of the prosthesis (40.7%). Mean follow-up was 76.12 months (0-176 months). Prosthesis survival was 69.7% at 5 years (95% CI, 62.2-77.3) and 58.5% at 10 years (95% CI, 50.0-66.9). In multivariate analysis, the factors influencing prosthesis survival were: type of prosthesis (other vs. Coloplast TITAN®, HR 1.89, CI 95%, 1.03-3.45) and prosthesis final length (20-29cm vs. 12-17cm, HR 0.27, 95% CI, 0.09-0.77). At 10 years, the penile prosthesis survival is close to 60%. Type of implant and final length of the prosthesis may have a significant influence in long-term prosthesis survival. Patients undergoing penile prosthesis implantation must be informed about the risk of surgical removal/revision of the prosthesis. 3.

When Titans become weak: penile prosthesis cylinder aneurysm, a case report

During the first 5 years after penile prosthesis implantation, complications such as malfunction requiring revision or replacement occur in only 7% of cases. We present a case of a 62-year-old patient who had a Coloplast Titan® prosthesis implanted while also undergoing girth enhancement corporoplasty. Shortly after, the patient noticed an increasing bulge on the side of his penis, which prevented total deflation. An aneurysm of the right cylinder was identified during reoperation; cylinders were replaced and the redundant tunica albuginea and septal defect were corrected by plication from inside the corpora cavernosa.

A Comparison Between AMS 700 and Coloplast Titan: A Systematic Literature Review.

There are only two three-piece inflatable penile prostheses (IPP) available to patients in the American market: the AMS (American Medical Systems) 700TM series (Boston Scientific, Massachusetts) and the Coloplast Titan® series (Coloplast, Minnesota), and data comparing the two are scant. The aim of our study was to summarize the current scientific evidence comparing the two.A systematic literature review was conducted on PubMed. A 10-year filter was placed to include only studies published after Coloplast launched the Titan Touch® release pump. Eligibility criteria included articles discussing specifically the AMS 700TM and Coloplast Titan® models. Further searches for studies on patient/partner satisfaction were conducted. s were reviewed to include studies focusing specifically on the models we are studying and studies on patient satisfaction using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire.The Coloplast device demonstrated slightly greater resistance to the stimulated forces of penetration and gravity. Coloplast implants coated with vancomycin/gentamicin had the highest infection rate followed by the AMS penile prosthesis and the rifampin/gentamicin coating had the lowest infection rate. Prosthesis durability and survival were similar between both brands. Overall satisfaction was high but comparisons are inconsistent.The literature is inconclusive about which device is superior. We suggest randomized, multicenter, prospective studies to help further elucidate the highlights of each product.

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.

A prospective study analyzing both inflation and deflation preference for commonly available inflatable penile prostheses.

Despite popularity, satisfaction rates of inflatable penile prosthesis (IPP) use can be improved by evaluating the ability to operate devices in the preoperative setting. The purpose of this study was to prospectively analyze the preference of three commonly available IPPs. In total, 125 IPP-naïve men 60 years of age or older were prospectively recruited from an outpatient Urology clinic from June 2019 to January 2020. A questionnaire standardized to all encounters was utilized to collect demographics, selected medical information, and key pinch strength. Participants were then asked to rank three models in terms of preference (from 1 to 3, 1 representing most preferred) for each inflation and deflation in a double-blinded manner. Statistical analysis was performed using ANOVA, a Chi-square test and multivariable logistical regression analysis. The results demonstrated preference for Coloplast Titan (44%) for inflation, and preference for AMS 700 (40%) for deflation. Men who preferred the Coloplast Titan inflation had a lower chance of preferring the AMS 700 MS deflation (OR = 0.29; p = 0.010) and Coloplast Titan Touch deflation (OR = 0.27; p = 0.012). Preference for Coloplast Titan was weakly associated with participant history of coronary artery disease (OR = 5.96, p = 0.006) and osteoarthritis (OR = 3.04, p = 0.044). Neither key pinch strength nor age was associated with preference for a particular model. IPP-naïve men over 60 years favor Coloplast Titan for inflation and AMS 700 for deflation, and men who preferred the Coloplast Titan for inflation were less likely to choose the AMS 700 MS or Coloplast Titan Touch for deflation. Further studies should aim to confirm these findings.

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

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.

PD20-10 EFFECT OF ANTIMICROBIAL DIPPING SOLUTIONS ON POST-OPERATIVE INFECTION RATES IN DIABETIC PATIENTS UNDERGOING PRIMARY INSERTION OF A COLOPLAST TITAN INFLATABLE PENILE PROSTHESIS

INTRODUCTION AND OBJECTIVE: Penile prostheses (PP) that are dipped in antimicrobial solutions can be specially selected by the implanter and tailored towards the patient. The best choice for antimicrobial solution is widely debated and remains a surgeon’s preference. We conducted a multi-institutional study of diabetic patients undergoing primary Coloplast Titan PP implantation and compared post-operative outcomes based on the antimicrobial solutions used for dipping. METHODS: Between April 2003 and May 2018, data was collected from 18 different institutions, and charts of 473 patients with diabetes receiving primary PP implantation with Coloplast Titan devices were reviewed. Antibiotics and antifungals used for device impregnation were recorded for each patient. Primary outcome was post-operative infection rate and secondary outcomes were explantation and revision rates. Patients had a median follow-up time of 7 months (range: 0 – 157). Patients were included in the analysis only if they had complete information regarding peri-procedural antimicrobial dip use and the above mentioned outcomes. Univariate comparisons of proportions were completed for rates of infection, explantation, and revision between different antimicrobial regimens. RESULTS: Overall, 468 patients had complete information and were included. The total number of infections, explantations, and revisions were 15 (3.3%), 18 (4.0%), and 27 (6.0%), respectively. Vancomycin + Gentamicin dipping solution was used in 276 devices, 177 devices were dipped in Gentamicin + a different antibiotic solution, of which 143 were dipped in Rifampin + Gentamicin. When comparing the number of infections, those dipped with Vancomycin + Gentamicin had significantly lower infections (1.4%) than those with Gentamicin + a different antibiotic (5.6%, p = 0.014), and those with Rifampin + Gentamicin (5.6%, p=0.014). There was no significant difference in infections when comparing implants that were dipped in Rifampin (158) vs. no Rifampin (310), (p = 0.057). In our cohort, 190 patients had an antifungal used in their dipping solution (Amphotericin) and 278 did not. In the group that had antifungals, there were 5 (2.6%) recorded infections compared to 11 (4.0%) in the group of patients that did not receive any antifungals (p = 0.414). CONCLUSIONS: The use of a Vancomycin + Gentamicin antibiotic dip seems to provide the greatest protection against post-operative infections compared to other antibiotic dips in diabetic patients. The use of antifungal dips, however, does not seem to provide an increased protection against post-operative infections in diabetic patients. Source of Funding: None

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