Partial Component Exchange of a Non-infected IPP is Associated with a Higher Complication Rate.
Thomas Alvermann, BS1, Britney Atwater, MD2, David Barham, MD3, Muhammed Hammad, MBBS3, David Swerdloff, MD4, Britany D. Berk, MD5, Eric Chung, MD6, Jonathan Clavell-Hernandez, MD7, Lawrence C. Jenkins, MD8, James M. Jones, BA1, Martin N. Kathrins, MD5, Aaron C. Lentz, MD9, Joshua Schammel, MD10, Jay Simhan, MD5, John P. Selph, MD11, Charles Welliver, MD10, Faysal A. Yafi, MD3, Martin S. Gross, MD2.
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 3Department of Urology, University of California, Irvine, Orange, CA, USA, 4Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA, 5Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA, 6Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia, 7Clavell Urology, Houston, TX; Division of Urology, Department of Surgery, University of Texas McGovern Medical School, Houston, TX, USA, 8Department of Urology, Tulane University, New Orleans, LA, USA, 9Division of Urology, Department of Surgery, Duke University, Durham, NC, USA, 10Division of Urology, Albany Medical College, Albany, NY, USA, 11Urology Associates of Nashville, Nashville, TN, USA.
Title: Partial Component Exchange of a Non-infected IPP is Associated with a Higher Complication Rate.
Background: Management of malfunctioning inflatable penile prostheses (IPPs) is varied. The impact of partial component exchange versus complete device exchange on complications is unknown. We sought to describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction.
Methods: We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components. Differences between baseline demographics were assessed with two tailed student t-tests and Fisher's exact tests. Multivariable analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications.
Results: 453 men underwent IPP revision. 368 had complete exchange of the entire device and 85 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (7.1% vs 2.2%, p=0.031). The partial exchange group also was more likely to receive antifungals (51.8 vs 16.8%, p<0.001), have a modified salvage washout (77.4 vs 60.2%, p=0.004), and less likely to receive vancomycin and gentamicin (63.5 vs 83.7%, p<0.001). Time to revision was significantly shorter in the partial exchange group (44.9 vs 168.2 months, p<0.001). In multivariable analysis, partial exchange surgery (OR 2.6, 95%CI 0.7-9.3, p=0.17),
vancomycin and gentamicin prophylaxis (OR 0.3, 95%CI 0.1-1.2, p=0.11), modified salvage washout (OR 1.8, 95%CI 0.3-9.2, p=0.48), and antifungal prophylaxis (OR 2.7, 95%CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of non-infectious complications (21.2% vs 9.5%, p=0.005) such as pump malfunction and tubing breakage.
Conclusions: While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases risks in men undergoing IPP revision for non-infectious indications.
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