Penile Implant: Review of a 'No-Touch' Technique

Introduction Over 25% of the more than 725,000 cases of nosocomial infection in the United States are related to an implantable device. Despite the standard typical strategies available, infection rates for breast implants, cerebrospinal shunts, and penile implants remain unacceptably high. This paper will review use of a “no-touch” technique in varied surgical procedures from orthopedic fracture repair, cerebrospinal fluid shunt placement, and breast reconstruction/augmentation to penile prosthesis implantation. Aim One of our aims was to investigate whether the “no-touch” concept was unique to the field of penile implants and if similar results were obtained in other subspecialties. The other was to examine whether the low infection rate initially obtained with the “no-touch” technique was maintained for a larger number of penile implant procedures. Methods The literature was reviewed for the use of the “no-touch” technique in procedures as varied as orthopedic fracture repair, cerebrospinal fluid shunt placement, breast reconstruction/augmentation, and penile prosthesis implantation. In addition, a single surgeon's experience with 3342 penile implant surgeries with and without the use of the “no-touch” technique was reviewed. Main outcome measure Penile implant infection rate was examined for 3342 consecutive cases between January 2002 and December 2014. Infection of standard technique was compared with rate of infection with antibiotic impregnated devices and starting in 2006 with the addition of the “no-touch” enhancement. Results Literature review revealed that the “no-touch” technique decreased postoperative cerebral shunt infection from 9.1% to 2.9%. Breast implant reconstruction surgical site infection decreased from 19% to none with the “no-touch” technique. Penile implant infection rate fell from 5.3% in 2002 to 1.99% with the use of antibiotic impregnated devices and to 0.44% with the addition of the “no-touch” technique. Conclusion Use of a “no-touch” technique involving a mechanical barrier makes a difference in preventing infection of an implantable device.