(274) A MULTICENTER EXAMINATION OF CONTEMPORARY PENILE PROTHESIS SURGERY INFECTION PROPHYLAXIS PRACTICES
Authors: Abou Chawareb E , Hammad MA , Barham DW , Azad BK , Miller JA , Lumbiganon S , Hotaling JM , Simhan J , Gross MS , Yafi FA 
Published: December 2024

Abstract

Introduction
High-level evidence to guide antimicrobial prophylaxis or irrigation solution usage in penile prosthesis surgery remains unclear. This results in variability in prophylaxis practice patterns among prosthetic urologists.

Objective
This study aims to investigate infection prevention prophylaxis patterns among penile prosthesis surgeons.

Methods
Following IRB approval, an anonymous online survey was distributed to prosthetic urologists within the Sexual Medicine Society of North America (SMSNA), the Society of Urologic Prosthetic Surgeons (SUPS), and the Society of Genitourinary Reconstructive Surgeons (GURS). The survey collected data on preoperative, perioperative, and postoperative antimicrobial prophylaxis measures. This included antibiotic types, duration, antifungal usages, implant dipping, and irrigation in a variety of common clinical scenarios.

Results
Of 107 responses, most respondents were male (86.9%), with 10-15 years (10.3%) or over 15 years (21.5%) of experience. The majority worked at academic centers (56.1%), and 31.8% were fellowship trained in andrology, while 49.5% were fellowship trained in reconstructive urology. For primary IPP insertion, 23.4% of surgeons prescribed oral preoperative antibiotics. The most common preoperative oral antibiotic type was trimethoprim/sulfamethoxazole (TMP/SMX) in 60.0%. Perioperative IV antibiotics were most commonly a combination of vancomycin and gentamicin dosed by weight (80 mg 6.5%, weight-based 64.5%). Implant dipping was common (61.7%), most often with vancomycin and gentamicin (34.8%). Postoperative oral antibiotics were prescribed by most surgeons (77.6%) for 6-7 days, primarily TMP/SMX (67.6%). In diabetic or immunosuppressed primary IPP insertion, preoperative antibiotics were prescribed by 28%, mostly with TMP/SMX (50.0%). All surgeons administered perioperative IV antibiotics, mainly vancomycin and gentamicin (10.3% 80 mg, 54.2% weight-based). Implant dipping was common (62.6%), most often with vancomycin and gentamicin (44.8%). Postoperative antibiotics were prescribed by most surgeons (81.3%) for 6-7 days, primarily TMP/SMX (65.5%). In revision IPP surgery, oral preoperative antibiotics were prescribed by 27.1%, with TMP/SMX a frequently selected option (51.7%). Perioperative IV antibiotics were administered by all surgeons, vancomycin and gentamicin (5.6% 80 mg and 58.9% weight-based). Implant dipping was common (63.6%), often with a combination of vancomycin and gentamicin (33.8%).Postoperative antibiotics were prescribed by most surgeons (87.9%) for 6-7 days, primarily TMP/SMX (66.0%). In salvage IPP surgery, 32.7% of surgeons prescribed preoperative oral antibiotics, mostly TMP/SMX (42.9%). Vancomycin and gentamicin (5.6% 80 mg and 50.4% weight-based) were most commonly given as IV perioperative prophylaxis. Implant dipping was common (66.4%), often with vancomycin and gentamicin (32.4%). 89.7% prescribed postoperative antibiotics, mostly for 6-7 days, primarily with TMP/SMX (58.3%). In each scenario, irrigation of the implant with 0.05% Chlorhexidine Gluconate was a common practice (range 57.9% to 60.7%). However, dipping the implant in it was less common (range 29.9% to 30.8%).

Conclusions
This study highlights variations in antimicrobial prophylaxis patterns among penile prosthesis surgeons. It shows prevalence of oral TMP/SMX for preoperative and postoperative oral prophylaxis, and IV vancomycin and gentamicin combination for perioperative intravenous prophylaxis. Further studies are needed to standardize IPP antimicrobial prophylaxis practices to improve patient outcomes and reduce the risk of postoperative infections.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout.