Abstract Introduction Review articles and textbook chapters have noted that infection rates in penile prosthesis (PP) revision surgeries have significantly decreased since the addition of infection-retardant coatings to implants at the turn of the century. The quantity of organisms cultured incidentally at the time of IPP revisions has also decreased, with a shift from indolent gram-positive isolates to more aggressive gram-negative and fungal organisms. This trend is thought to be related to the introduction of infection-retardant coatings, better skin prep, improved surgical techniques, and evolving intraoperative antiseptic solutions. Objective This study retrospectively collects data to quantify bacterial isolates from more than 40 years of implant experience, forming a bacterial timeline that demonstrates the current drastic depopulation of implant spaces by culturable organisms. We hypothesize that, due to changes in surgical technique and device design, the rates and types of organisms cultured during revision surgery have significantly decreased. Methods Our data are divided into four sequential periods of time. The date of the implantation of the PP, not the date of the revision surgery, was used to group patients into time intervals. Greater than 100 patients with penile prostheses underwent revision surgery with intraoperative cultures between November 1995 and June 2004 at four institutions. Beginning in 2004, a single surgeon initiated a new practice and, over the next 21 years, performed more than 500 revision surgeries with incidental cultures. During this time, three distinctly different infection-control disciplines were applied to his patient population. Cultures were consistently obtained upon entering the pump space using a swab sent for culture and sensitivity. The distinguishing factors among the groups were as follows: Group A: Traditional skin preparation with Betadine and usage of non-coated PP devices. (before 2001) Group B: Infection-retardant coated PP devices and Chlorohexidine skin prep (2001–2009). Group C: Addition of the “no-touch” technique and hemostatic “mummy wrap” without closed drainage. (2010-2019) Group D: From 2020 to the present, continuation of all prior enhancements with addition of preoperative IV antifungal and change to antiseptic irrigations. Results Traditional culture isolates found at the time of revision penile prosthesis surgery (for any reason) decreased markedly across the four eras of evolving infection-control techniques (test for trend; p 0.0001). Among the total 509 patients, the overall positive culture rate was 30.5%. In the first era (devices placed before 2001), the positive culture rate was 67.6%, compared with only 2.9% in the fourth era (devices placed after 2019) (p 0.001). See Table 1. Conclusions Over a timeline spanning more than four decades, the rate of organisms cultured incidentally during revision surgery has drastically decreased. Changes in skin preparation, surgical technique, device coatings, and intraoperative antiseptic solutions appear to have significantly reduced culture-positive rates. For the first time in the literature, the impact of these infection-control advancements demonstrates a major decline in bacterial load cultured during revision surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Signati, Focal One, Microgen DX, Blue Wind, Irrimax, Pfizer
Henry et al. (Mon,) studied this question.