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Natsos A, Tatanis V, Lekkou A, Kontogiannis S, Vagionis A, Spinos T, Peteinaris A, Obaidat M, Pagonis K, Kallidonis P, Liatsikos E, Drettas P. Unveiling the Hidden Perils: A Comprehensive Review of Fungal Infections in Inflatable Penile Prosthesis Surgery. J Pers Med 2024; 14:644. [PMID: 38929865 PMCID: PMC11204475 DOI: 10.3390/jpm14060644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Inflatable penile prosthesis (IPP) surgery is an effective treatment for erectile dysfunction (ED), but infections pose a significant threat to its success. Current guidelines lack antifungal recommendations, despite rising fungal infection rates post-IPP surgery. This review examines epidemiology, risk factors (including diabetes mellitus, immunosuppression, and obesity), and pathogenesis, highlighting the role of biofilm formation in device contamination. Clinical manifestations vary from acute to delayed, with fungal biofilms presenting challenges in diagnosis. Prophylactic strategies, including broad-spectrum antibiotics and antifungals, are crucial, with evidence suggesting a 92% reduction in infections. With fungal infections showing lower salvage rates, management involves culture-guided treatment, irrigation, and oral antibiotics. Future research aims to understand biofilm mechanisms and develop biomaterials to reduce infection rates. Implementing antifungal therapy, along with standard practices like the no-touch technique and antibiotic dips, is crucial in preventing IPP infections.
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Affiliation(s)
- Anastasios Natsos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Alexandra Lekkou
- Department of Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece;
| | - Stavros Kontogiannis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Athanasios Vagionis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Angelis Peteinaris
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Mohammed Obaidat
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Petros Drettas
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (S.K.); (A.V.); (T.S.); (A.P.); (M.O.); (K.P.); (P.K.); (E.L.); (P.D.)
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Sun HH, Callegari M, Zhou E, Rhodes S, Brant A, Jesse E, Prunty M, Shoag JE, Scarberry K, Mishra K, Gupta S. Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery. Neurourol Urodyn 2023. [PMID: 37209242 DOI: 10.1002/nau.25206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION AND OBJECTIVE Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. METHODS The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS-related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline-adherent antibiotics was done via chi-squared and Kruskal-Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline-adherent versus nonadherent regimens. RESULTS Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline-adherent antibiotics. The odds of guideline-adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline-adherent antibiotics by the end of the study period. Patients with guideline-adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74-0.93) and surgical revision (OR: 0.85, 95% CI: 0.74-0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68-1.17) within 3 months. CONCLUSIONS Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline-adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.
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Affiliation(s)
- Helen H Sun
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Callegari
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Eric Zhou
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
| | - Aaron Brant
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Erin Jesse
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Megan Prunty
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jonathan E Shoag
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kyle Scarberry
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kirtishri Mishra
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shubham Gupta
- Urology Institute, University Hospitals Cleveland Health System, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Brant A, Lewicki P, Punjani N, Kang C, Marinaro J, Callegari M, Prunty M, Thirumavalavan N, Halpern JA, Shoag JE, Kashanian JA. Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort. Urology 2023; 172:131-137. [PMID: 36450316 DOI: 10.1016/j.urology.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. MATERIALS AND METHODS The Premier Healthcare Database was queried for inflatable penile prosthesis surgeries from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent antimicrobial regimen and secondary outcome was 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before vs after guideline publication. Multivariable logistic regression models were constructed for primary and secondary outcomes. RESULTS A total of 26,574 patients who underwent inflatable penile prosthesis surgery were identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline publication, there was a 42% relative increase in AUA-adherent regimen usage, with an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R2 = 0.75, P < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. CONCLUSIONS Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.
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Affiliation(s)
- Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Nahid Punjani
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Caroline Kang
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Jessica Marinaro
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Michael Callegari
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Megan Prunty
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nannan Thirumavalavan
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - James A Kashanian
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
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