Reduced Penile Prosthesis Infection Rates with Intraoperative Irrigation using Vancomycin/Gentamicin vs Povidone-Iodine

30 Jul, 20

Introduction

Penile prosthesis (PP) surgery has been successful in medically refractory erectile dysfunction (ED), but infection rate has been a persistent complication of PP surgery. Washout protocols have reduced the infection rates. The literature shows that the antiseptics used in the washout protocols could have cytotoxic effects. Hence there is a need for safer and more effective regimens. The researchers of this study changed intraoperative irrigation from 5% povidone-iodine to vancomycin/gentamicin to compare the infection rates.

Aim

The current study compared the infection rate with intraoperative irrigation using ½ strength povidone-iodine and vancomycin/gentamicin at the time of both virgin and revision PP surgery and evaluated the other potential confounders.

Method

Study Design

Retrospective, case-controlled, single center study

Treatment Strategy

The records of men undergoing primary, revision, and salvage PPs were prospectively reviewed.
Irrigation was performed using 5% povidine-iodine or vancomycin 1 g/gentamicin 80 mg in 1 liter normal saline
The operative or perioperative techniques remained the same with either of the irrigation solution.
The infection rates were evaluated
Potential confounders were reviewed.

Endpoints

PP infection rate before and after change of intraoperative irrigation

Results

PP placement was performed by a single surgeon on 217 patients
Overall infection rate was 9.7%, out of which 7.1%, 17.19% and 0% infections occurred in men undergoing primary, revision and salvage surgeries respectively
Irrigation was done with povidone-iodine and vancomycin/gentamicin in 70% and 30% respectively
Univariate analysis demonstrated significantly increased infection rates with povidone-iodine irrigation (odds ratio [OR]: 4.64, p=0.006) and with revision surgery (OR: 2.68, p=0.02)
The elevated infection rate with povidone-iodine persisted after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy (OR: 9.3; p = 0.025)
Significance of increased infection rate with revision surgery was maintained after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy (OR: 3.26; p = 0.047)

Conclusion

Use of povidone-iodine irrigation was associated with a 9-fold increased likelihood of penile prosthesis infection
The results demonstrated significant reduction in the infection rates when the irrigation solution was changed from povidone-iodine to vancomycin/gentamicin among men undergoing penile prosthesis placement in both primary and revision cases.
The relative toxicity or non-sterile nature of povidone-iodine might be correlated to the differences in the infection rates.

Sex Med 2020 Jun,1-6. Doi: 10.1016/j.esxm.2020.05.010.