Abstract: PD22-12
Sources of Funding: None

Introduction

Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements and adoption of antibiotic prophylaxis guidelines. This study compares inflatable penile prosthesis (IPP) infections in patients who received standard dose, non-weight-based (NWB) intravenous gentamicin preoperatively versus high dose, weight-based (HD) intravenous gentamicin as antibiotic prophylaxis.

Methods

This study is a retrospective cohort comparison of 139 consecutive IPP patients who underwent implantation by a single surgeon between November 2014 and April 2015 using 1gram of IV vancomycin and 80 mg NWB IV gentamicin. These patients were matched with 184 consecutive IPP patients who underwent implantation between May 2015 and December 2015 using 1 gram of IV vancomycin and HD IV gentamicin dosed for 5 mg/kg of actual body weight. Patient data were compiled after extensive review of operative reports, inpatient notes, consult notes, and follow-up visits. Age, comorbidities, overall health status, IPP manufacturer, and oral antibiotics received 2 days prior to surgery were similar between the two cohort groups. Surgical technique and antibiotic irrigation were also indistinguishable between the cohorts. We performed univariate statistical analysis to determine significant predictors of infectious complications.

Results

The NWB patients suffered four postoperative IPP infections (2.8%). Three of four implants were in patients who had undergone primary implantation. One implant patient in the NWB gentamicin cohort had an infection after device removal and replacement. Two of these four patients underwent successful salvage with malleable implants, the rest underwent device explant. In contrast, none of the patients (0.0%) in the HD gentamicin cohort had a postoperative infection. The HD gentamicin cohort included 17 removal and replacement patients.

Conclusions

An antibiotic prophylaxis regimen consisting of high dose, weight-based gentamicin along with vancomycin reduced the rate of infectious complications in our series of patients undergoing IPP implantation. Further prospective studies are needed to compare NWB and HD gentamicin dosing to determine the utility of this regimen in primary implant and revision implant cases.

Funding

None