World J Mens Health.  2019 Sep;37(3):276-287. 10.5534/wjmh.180123.

Penile Prosthesis Infection: Myths and Realities

• Hebert KJ
• Kohler TS

• KMID: 2455405
• DOI: http://doi.org/10.5534/wjmh.180123

Abstract

Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), Staphylococcus aureus nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), "No Touch" technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.

Keyword

Erectile dysfunction; Infection; Penile implant; Penile prosthesis; Sexual dysfunction, physiological

MeSH Terms

Anti-Bacterial Agents
Erectile Dysfunction
Evidence-Based Medicine
Hair Removal
Hand
Health Care Costs
Humans
Immunosuppression
Male
Obesity
Penile Prosthesis*
Prostheses and Implants
Risk Factors
Sexual Dysfunction, Physiological
Smoke
Smoking
Spinal Cord Injuries
Staphylococcus aureus
Stress, Psychological
T-Lymphocytes
Tobacco
Urinary Diversion
Anti-Bacterial Agents
Smoke

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