(142) HYDROPHILIC INFLATABLE PENILE PROSTHESIS SURFACES READILY REBIND ANTISEPTIC SOLUTIONS EX VIVO
Authors: Im B , Giordano AH , Shah S , Guillaume S , Evans R , Perez C , Fertala A , Fertala J , Hickok NJ , Chung PH 
Published: December 2024

Introduction

During revision penile prosthesis (PP) surgery, existing implant components may be reused (i.e., repair of an impending cylinder extrusion, reservoir herniation, or pump relocation). To date, no studies have evaluated the ability of the existing hydrophilic PP surface to rebind antiseptic solutions during revision surgery and potentially confer antimicrobial protection.

Objective

We hypothesize that the PP hydrophilic surface coating retains its binding properties and maintains antimicrobial efficacy comparable to that of a new implant ex vivo.

Methods

This study does not constitute human research, as discarded materials without the use of patient identifiers were used. 3 reservoirs and 2 cylinders were sourced from 3 patients who underwent revision Coloplast Titan PP surgery. Congo Red staining of the implant was performed immediately after removal in the operating room and after sterilization in the lab. Congo Red staining is used by Coloplast to evaluate the integrity of the hydrophilic coating. A new, sterile reservoir was used as a control. Sterile 8 mm PP discs were submerged for 3 minutes in 3 mL of normal saline (NS), 0.05% chlorhexidine gluconate (CHG), or a 2 mg/mL vancomycin and 160 μg/mL gentamicin (VG) solution, rinsed in NS for five seconds, then incubated with 10^5 colony-forming units per milliliter (CFU)/mL of methicillin-sensitive Staphylococcus aureus ATCC25923 in trypticase soy broth (TSB) for 48 hours. Samples were rinsed with PBS and biofilm was removed by shaking in 0.3% Tween-20. Suspended bacteria were serially diluted, plated onto 3 M PetriFilms, and counted. Sterile 8 mm PP discs were submerged for 3 minutes in either fluorescein-isothiocyanate (FITC) labelled (Sigma Aldrich, St. Louis, MO) or unlabeled vancomycin at 2 mg/mL, after which the discs were rinsed in NS. Initially, the unlabeled PP discs were viewed to assess for any baseline fluorescence, after which unlabeled and FITC-vancomycin PP discs were viewed. Quantification of all fluorescence was done via ImageJ. Mann–Whitney U and one-way ANOVA tests were performed to compare outcomes, p &lt; 0.05 considered significant.

Results

Implants stained evenly with Congo Red by gross visualization immediately after removal in the operating room and after sterilization in the lab (Fig. 1a). Average bacterial counts with 95% CI are plotted in Fig. 1b. For all implants, there were significant decreases in bacterial counts in the VG groups relative to NS (p &lt; 0.01). However, only two (40%) of the 0.05% CHG implants exhibited significant (p &lt; 0.05) decreases in bacterial counts relative to NS. Bacterial counts on the control implant were similar to explanted PP devices across all three treatment groups (p &gt; 0.05). Average fluorescence with 95% CI are plotted in Fig. 1c with images shown in Fig. 1d. Significant increases in fluorescence were present across all implants in the FITC-vancomycin labeled group relative to unlabeled vancomycin controls (p &lt; 0.0001).

Conclusions

Hydrophilic PP surfaces remain viable and bind vancomycin based on ex-vivo Congo Red staining and FITC-vancomycin binding studies. The hydrophilic surfaces also retain antimicrobial properties and reduce bacterial binding, while VG was more effective than 0.05% CHG. Further studies are indicated to identify the clinic benefit of these findings.

Disclosure

Yes, this is sponsored by industry/sponsor: Coloplast.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific.