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Prosthetic sparing surgery: risk factors for infection and keys to success

Shah, B1; Binner, M1; Beilan, J1; Baumgarten, A1; Parker, J1; Carrion, R1Slongo, J1

1: University of South Florida, United States

Objectives: Prosthetic sparing surgery (PSS) is defined as revision surgery for inflatable penile prosthetics that involves preservation of at least one component of the prosthesis. It is unclear if the decreased operative time associated with PSS counter balances the theoretical risk of infection associated with residual biofilm in the unchanged prosthetic. This series aims to assess our PSS series in effort to identify characteristics associated with infection risk.

Materials and Methods: Among 871 individual penile implant procedures performed at our university between October 1, 2011 and April 10, 2017, 53 patients were identified to have undergone PSS. Patients were divided into two groups: group 1, composed of 9 patients who had an infectious complication resulting in explantation following PSS, and group 2, composed of 44 patients with no post-surgical infections. Pre-operative demographics, intraoperative characteristics, and post-operative outcomes were evaluated using student t-test for continuous variables and Fisher’s exact test for categorical variables.

Results: Infection rate of the total cohort was 16.9%. A statistical difference in median patient age between groups 1 and 2 (77 vs. 68, p<0.018) was identified. There was no statistical difference in the number of patients with diabetes, procedure operative time, use of anti-bacterial irrigation during PSS, and number of prior surgeries. Among patients in group 1, the median time between PSS and explantation was 38 days (range: 8-78 days).  Among the 10 patients who underwent a no-touch technique during their PSS, only one had a subsequent infection, which was secondary to development of a urethro-corporal fistula. Median follow up was 366 days.

Conclusion: Our PSS series had an elevated infection rate compared to the 10% reported risk associated with revision surgery. In our series, older patients had an increased risk of prosthesis infection, while implementation of the no-touch technique during the procedure may be protective against infections.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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