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Use of 0.05% Chlorhexidine Gluconate Is Associated with Inflatable Penile Prosthesis Wound Complidations in a Multi-Institutional Cohort
Benjamin H. Rosenfeld, MD1, Martin S. Gross, MD1, David Han, MD2, Muhammed Hammad, MBBCh3, Samuel Ivan, MD2, Elia Chawareb, MD3, Faysal Yafi, MD3, Thairo Pereria, MD4, Jacob Good, MD5, Helen Bernie, DO5, Nicklas Sarantos, MD6, Aaron Lentz, MD6, Alredo Suarez-Sarmiento, MD7, Paul Perito, MD7, Joshua Schammel, MD8, Charles Welliver, MD8, Zayda Dominick, MD9, Ketch Cowan, MD9, Anand Shridharani, MD9, Brian Im, MD10, Paul Chung, MD10, Vi Nguyen, MD11, Michael Hsieh, MD11, David Barham, MD12, Jay Simhan, MD2.
1Dartmouth Health, Lebanon, NH, USA, 2Fox Chase Cancer Center, Philadelphia, PA, USA, 3University of California Irvine, Irvine, CA, USA, 4University of Rochester Medical Center, Rochester, NY, USA, 5Indiana University Health, Indianapolis, IN, USA, 6Duke Health, Durham, NC, USA, 7Perito Urology, Coral Gables, FL, USA, 8Albany Med Health System, Albany, NY, USA, 9Erlanger Health System, Chattanooga, TN, USA, 10Jefferson Health, Philadelphia, PA, USA, 11University of California San Diego, San Diego, CA, USA, 12Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Background: There are multiple available irrigation solutions to use during implantation surgery. We sought to determine whether the use of 0.05% Chlorhexidine Gluconate (CHG) during inflatable penile prosthesis (IPP) surgery was associated with certain non-infectious wound complications.
Methods: We performed a multi-institutional retrospective cohort study of patients undergoing IPP surgery from January 2017 to March 2024. The primary outcome was non-infectious complications: skin/wound complications (ex. rash, wound dehiscence, edema), device malfunction, pain, lower urinary tract symptoms including urinary retention, and device erosion. The primary exposure was whether patients received intra-operative CHG either as irrigation or dip. Descriptive comparisons and multivariable logistic regression analysis was performed to assess factors associated with non-infectious complications after IPP surgery.
Results: Across 2,908 patients undergoing IPP placement, there were 1,346 CHG patients and 1,562 non-CHG patients. CHG patients were more likely to have hypertension (68.1% vs. 60.3%, p<0.01). There was no difference in age, obesity, diabetes, or coronary artery disease. Non-infectious complications occurred in 55 (4%) CHG patients and in 63 (4%) non-CHG patients. On multivariable logistic regression CHG use was associated with skin/wound complications (OR 3.3, 95% CI 1.2-8.8) but not mechanical malfunction (OR 0.6, 95% CI 0.2-1.4) when controlling for age, body mass index, race, diabetes, and hypertension. Adjusting for all non-infectious complications in a single model, multinomial logistic regression with bootstrapping revealed that skin/wound complications remained associated with CHG use (OR 3.9, 95% CI 1.8-7.0). Post-operative pain was also associated with CHG use (OR 2.4, 95% CI 1.1-5.1).
Conclusions: In a large multi-institutional cohort, CHG use during IPP surgery appears to be associated with post-operative wound complications. While evidence may suggest an association with CHG use and pain, there were no statistically significant differences for all other non-infectious complications between CHG and non-CHG patients.
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