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Intraoperative Use of Vancomycin Paste during Penile Prosthesis Placement: Initial Outcomes
Priyanka Bearelly, MD, MPH1, Maria D’Amico, MD1, Shu Pan, MD2, Nannan Thirumavalavan, MD3, Martin Gross, MD4, Pedro Maria, MD5, Ricardo Munarriz, MD1.
1Boston University, Boston, MA, 2NorCal Urology, Walnut Creek, CA, 3Case Western Reserve University, Cleveland, OH, 4Dartmouth-Hitchcock Medical Center, Lebanon, NH, 5Montefiore Medical Center, Bronx, NY.

IntroductionPenile prostheses are safe and effective treatment options in the management of severe vasculogenic ED. It is associated with high satisfaction rates in addition to low and acceptable complication rates. Penile prosthesis infection is rare (0.5% to 3%) but can be physically and emotionally devastating for the patient. Although these rates have decreased over the past years with surgeon and device dependent improvements, innovative infection prevention measures are welcome. Vancomycin paste has been used by cardiothoracic surgeons since at least 2007 in an effort to reduce sternal wound infections. Numerous studies have shown that the use of vancomycin paste has an excellent safety profile and has significantly reduced wound site infections, both deep and superficial. We have adopted its use to provide prolonged focal antibiotic exposure around the penile prosthesis pump, a location that is susceptible to the majority of penile prosthesis infections. ObjectiveThe aim of the study is to determine whether vancomycin paste can be safely used intraoperatively as an additional step for infection prevention during penile prosthesis placement. MethodsA multi-institutional chart review of patients who underwent placement of a virginal inflatable penile prosthesis (IPP) with intraoperative use of vancomycin paste (3 gm) was conducted to determine initial outcomes. Adverse outcomes were of particular interest and were categorized in the following manner: penile prosthesis pump-related issues such as fibrosis, persistent pain, and difficult manipulation; as well as standard complications including infection, erosion, hematoma and complete device malfunction.ResultsFrom April 2019 to October 2019, 90 patients underwent virginal IPP surgery during which vancomycin paste (3 gm) was placed in the scrotum to encircle the pump. Surgical technique, use of irrigations, and drain placement remained consistent per routine protocol. To date, five patients have experienced adverse events, including deep wound infection, superficial wound infection, and scrotal hematoma. Of the five patients, only one experienced a true infection requiring explant, ultimately demonstrating an infection rate of 1.1%.ConclusionsVancomycin paste is a safe intraoperative infection prevention measure during IPP surgery. The infection rate within this cohort of patients is in congruence with what is found in today's literature. Nonetheless, no conclusions can be drawn regarding the ability of Vancomycin paste to prevent infections. Future prospective studies are necessary to further examine its efficacy.


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