Emerging Data Regarding Fungal Infections of Inflatable Penile Prostheses
Martin S. Gross, MD1; Gerard D. Henry, MD2; Stanton C. Honig, MD3; Peter J. Stahl, MD4; Arthur L. Burnett, MD5; Pedro P. Maria, DO6; Nelson E. Bennett, Jr., MD7; Rafael E. Carrion, MD8; Tobias S. Kohler, MD9; Ricardo M. Munarriz, MD10
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH; 2Ark-La-Tex Urology, Shreveport, LA; 3Yale University School of Medicine, New Haven, CT; 4Columbia University College of Physicians and Surgeons, New York City, NY; 5The Johns Hopkins University School of Medicine, Baltimore, MD; 6Albert Einstein College of Medicine, New York City, NY; 7Northwestern University Feinberg School of Medicine, Chicago, IL; 8University of South Florida Morsani College of Medicine, Tampa, FL; 9Mayo Clinic, Rochester, MN; 10Boston University School of Medicine, Boston, MA
BACKGROUND: Fungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. We reviewed our multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infection.
METHODS: This is a retrospective IRB-approved analysis of 213 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after extensive review of operative reports, nursing operative data, intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and follow-up visits. Twenty patients with fungal infections were identified and additional information was requested.
RESULTS: Fourteen patients underwent primary IPP implantation, the other 6 had previously undergone an average of 1.5 IPP-related surgeries (range 1-3, median 1). Average age at implantation was 58 (range 31-72, median 60). Thirteen of the 20 fungal infection patients were diabetic (65%), the rest were not. Of the diabetic patients mean HgbA1c was 8.7 (range 6.5-13.3, median 8.3). Mean BMI for all patients was 30.9 kg/m2 (range 23.7-45 kg/m2, median 31 kg/m2). Mean BMI for diabetic patients was 31.8 kg/m2 (range 24.1-45 kg/m2, median 32 kg/m2). Ninety percent of implants were placed with IV antibiotics consistent with current AUA guidelines. In seven of these cases, fungi and bacteria were found in culture together. Eight devices were explanted, 8 underwent malleable implant salvage (MIST), and 4 were salvaged in the classic Mulcahy technique. Of the 8 patients who underwent explant, 5 later had successful reimplantation with either a malleable prosthesis or an inflatable prosthesis. The other three remain without an implant at last follow-up. Two of the 20 fungal infection patients were incontinent at IPP implantation. One of these patients underwent simultaneous Virtue sling implantation. No patient had concomitant immunosuppressive disease aside from DM at IPP implantation. No patient had evidence of recent antibiotic exposures prior to IPP implantation.
CONCLUSIONS: To our knowledge these data represent the first in-depth exploration of IPP patients presenting with fungal infections. Approximately two-thirds of the patients were diabetic, suggesting that additional prophylaxis may be appropriate for diabetic patients. Further investigation is needed to confirm our results.
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