Investig Clin Urol.  2018 Sep;59(5):342-347. 10.4111/icu.2018.59.5.342.

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training

• McAbee KE
• Pearlman A
• Terlecki R

• KMID: 2419418
• DOI: http://doi.org/10.4111/icu.2018.59.5.342

Abstract

PURPOSE
Primary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved.
MATERIALS AND METHODS
Review of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery.
RESULTS
Three hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%.
CONCLUSIONS
In this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.

Keyword

Infection; Penile prosthesis; Risk factors

MeSH Terms

Device Removal
Follow-Up Studies
Humans
Incidence
Male
Penile Prosthesis*
Polytetrafluoroethylene
Primary Health Care
Prospective Studies
Risk Factors
Skin
Teaching*
Polytetrafluoroethylene

Reference

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994; 151:54–61. PMID: 8254833.

2. Levine LA, Becher E, Bella A, Brant W, Kohler T, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016; 13:489–518. PMID: 27045255.

3. Trost LW, McCaslin R, Linder B, Hellstrom WJ. Long-term outcomes of penile prostheses for the treatment of erectile dysfunction. Expert Rev Med Devices. 2013; 10:353–366. PMID: 23668707.

4. Holland B, Kohler T. Minimizing penile implant infection: a literature review of patient and surgical factors. Curr Urol Rep. 2015; 16:81. PMID: 26480830.

5. Eid JF, Wilson SK, Cleves M, Salem EA. Coated implants and “no touch” surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46%. Urology. 2012; 79:1310–1315. PMID: 22521187.

6. Henry GD, Wilson SK. Updates in inflatable penile prostheses. Urol Clin North Am. 2007; 34:535–547. vi. PMID: 17983893.

7. Mishail A, Maggio-Ferguson A, Lee W, D'Amato A. Perception vs reality: how primary care physicians understand prosthetic urology. J Urol. 2016; 195:e630.

8. Pestana C. Dr. Pestana's surgery notes. 2nd ed. New York: Kaplan Publishing;2015.

9. Carruthers KH, McMahan JD, Taylor A, Pearson G, Tiwari P, Kocak E. Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations. J Surg Educ. 2015; 72:477–482. PMID: 25572941.

10. Matulewicz RS, Pilecki M, Rambachan A, Kim JY, Kundu SD. Impact of resident involvement on urological surgery outcomes: an analysis of 40,000 patients from the ACS NSQIP database. J Urol. 2014; 192:885–890. PMID: 24704012.

11. Schommer E, Tonkovich K, Li Z, Thiel DD. Impact of resident involvement on robot-assisted radical prostatectomy outcomes. J Endourol. 2016; 30:1126–1131. PMID: 27445128.

12. Kent M, Whyte R, Fleishman A, Tomich D, Forrow L, Rodrigue J. Public perceptions of overlapping surgery. J Am Coll Surg. 2017; 224:771–778.e4. PMID: 28196693.

13. Nigussie S, Belachew T, Wolancho W. Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia. BMC Surg. 2014; 14:67. PMID: 25189274.

14. Wu J. You should want surgery residents for your operation. Here's why [Internet]. Kevin MD;2016. cited 2016 Apr 19. Available from: https://www.kevinmd.com/blog/2016/04/you-should-want-surgery-residents-for-your-operation-heres-why.html.

15. Jena AB, Sun EC, Romley JA. Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study. Circulation. 2013; 128:2754–2763. PMID: 24152859.

16. Webster H. Is surgery safer at a teaching hospital? [Internet]. US News;2014. cited 2014 Oct 27. Available from: https://health.usnews.com/health-news/patient-advice/articles/2014/10/27/is-surgery-safer-at-a-teaching-hospital.

17. Kern SQ, Lustik MB, McMann LP, Thibault GP, Sterbis JR. Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol. 2014; 28:40–47. PMID: 24007345.

18. Ruhotina N, Dagenais J, Gandaglia G, Sood A, Abdollah F, Chang SL, et al. The impact of resident involvement in minimally-invasive urologic oncology procedures. Can Urol Assoc J. 2014; 8:334–340. PMID: 25408800.

19. Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996; 156:402–404. PMID: 8683689.

20. Selph JP, Carson CC 3rd. Penile prosthesis infection: approaches to prevention and treatment. Urol Clin North Am. 2011; 38:227–235. PMID: 21621089.

21. Cakan M, Demirel F, Karabacak O, Yalçinkaya F, Altuğ U. Risk factors for penile prosthetic infection. Int Urol Nephrol. 2003; 35:209–213. PMID: 15072498.

22. Mulcahy JJ, Carson CC 3rd. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011; 60:167–172. PMID: 21316145.

23. Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R. Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care. 2014; 37:611–616. PMID: 24170760.

24. Dhatariya K, Levy N, Kilvert A, Watson B, Cousins D, Flanagan D, et al. NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med. 2012; 29:420–433. PMID: 22288687.

25. Dhatariya K. Comment on Underwood. . Comment on Underwood et al. Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care. 2014; 37:611–616. e190. PMID: 24170760.

26. Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012; 147:373–383. PMID: 22508785.

27. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg. 1995; 61:1001–1005. PMID: 7486411.

28. Huttunen R, Karppelin M, Syrjänen J. Obesity and nosocomial infections. J Hosp Infect. 2013; 85:8–16. PMID: 23920442.

29. Wong C, Goldstein DR. Impact of aging on antigen presentation cell function of dendritic cells. Curr Opin Immunol. 2013; 25:535–541. PMID: 23806201.

30. Chung E, Solomon M, DeYoung L, Brock GB. Clinical outcomes and patient satisfaction rates among elderly male aged ≥75 years with inflatable penile prosthesis implant for medically refractory erectile dysfunction. World J Urol. 2014; 32:173–177. PMID: 23708698.