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The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed. We found that penile prosthesis infections occurred more commonly in June (n = 24) and less frequently during the winter months (n = 39), with the lowest number occurring in March (n = 11). One-hundred thirty-nine infections occurred at average daily temperatures greater than 55 °F, compared to 72 infections at less than 55 °F. The incidence rate ratio for this trend was 1.93, with a p-value of

INTRODUCTION AND OBJECTIVE:Inflatable penile prosthesis (IPP) is a well-established treatment for medically refractory erectile dysfunction. Infection is the most dreaded complication and the major...

The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed. We found that penile prosthesis infections occurred more commonly in June (n = 24) and less frequently during the winter months (n = 39), with the lowest number occurring in March (n = 11). One-hundred thirty-nine infections occurred at average daily temperatures greater than 55 °F, compared to 72 infections at less than 55 °F. The incidence rate ratio for this trend was 1.93, with a p-value of0.001. Humidity results were similar, and fungal infections correlate with daily humidity. Infected implants performed in the fall and summer were over 3 and 2.3 times, respectively, more likely to grow Gram-positive bacteria compared to implants performed in spring (p = 0.004; p = 0.039). This was consistent across geographic location, including in the Southern hemisphere. We found trends between climate factors and IPP infection like those seen and proven in other surgical literature. To our knowledge these data represent the first exploration of the relationship between temperature and infection in prosthetic urology.

Introduction and Objectives Implantation of a penile prosthesis in a patient with significant corporal fibrosis can pose a significant challenge to the surgeon, necessitating the knowledge of specific techniques used to dilate and close aggressively scarred corpora. The objective of our instructional video is to discuss 2 techniques used to approach corporal fibrosis: proper and safe use of cavernotomes for dilation and use of narrower prostheses. Methods In this video, we present a 53-year-old man with a history of priapism 3 years ago that lasted 4 days in the setting of trazodone use. He was managed with corporal irrigation and subsequently developed severe erectile dysfunction. Notably, the patient had a history of sickle cell anemia, and on physical examination was noted to have densely fibrotic corpora. After extensive counseling regarding options, he chose a penile implant. The surgical was planned using the “no touch technique.” After the corporotomies were made, we began dilating the corpora. Hegar dilators and Dilamezinsert were attempted at first but met significant resistance. We switched to cutting cavernotomes and were able to dilate up to 11-Fr distally and up to 13-Fr proximally. The proper use of cavernotomes is highlighted in our video, with care being taken to aim the cutting edge of the cavernotome laterally away from the urethra. We also used the narrowest inflatable prosthesis available to us (Coloplast Titan narrow-base) and describe the narrower devices available in inflatable and malleable forms as an option for less-than-ideally dilated corpora. The pump and reservoir placement was completed uneventfully. Results The patient was admitted overnight for observation and check of a complete blood count given his history of sickle cell anemia. He was able to be discharged after 23 hours of observation. The patient presented to the clinic 4 weeks later for pump activation. He was able to achieve good rigidity and had a penile length adequate for penetration after maximal activation. Conclusion This video discusses the approach to penile prosthesis placement in patients with significant corporal fibrosis. It highlights the proper use of cutting cavernotomes and the availability of narrow-diameter prostheses, both malleable and inflatable.

We report a case of malfunction of an inflatable penile prosthesis (IPP) after prostatic urethral lift (PUL) necessitating surgical intervention. A 70 year-old male underwent PUL for benign prostatic hyperplasia after IPP implant for organic erectile dysfunction. After PUL, the patient experienced IPP malfunction where he underwent subsequent IPP removal and replacement. A pinhole defect was noted in the reservoir upon removal attributable to PUL. Performing PUL before IPP implantation should be considered in light of potential iatrogenic PUL needle deployment injury.