Abstract | November 18, 2023
Comparing Bacterial Presence with the Usage of 0.05% Chlorhexidine Gluconate (CHG) Lavage During Urologic Prosthesis Revision Surgery
Learning Objectives
- Describe the current thought in prevention of prosthetic infections.
- Identify what types of irrigations have been used to reduce implant infections.
- How bacterial presence was measured quantitatively in this experiment.
Background
An Inflatable Penile Prosthesis (IPP) is the most common penile implant used to treat Erectile dysfunction (ED), Peyronie’s disease, and other penile deformities in the USA. IPP uses a fluid-filled reservoir with a pump and valve system to activate inflation and deflation. Although penile implants achieve the highest success rates in ED treatment, the possible presence of bacteria on the device itself or bacteria exposure accumulated during the surgery increases the risk of progression into biofilm or infection. Biofilm complicates the bacteria eradication effort and can ultimately jeopardize the implant. Often, the only way to treat the post-op infection is with implant removal. Currently, many preventative measures, such as different perioperative irrigations, are being studied to reduce the number of penile implant infections. Research has shown that irrigation at the time of both infectious and noninfectious surgery lowers subsequent infection rates. Different solutions like saline, antibiotic, betadine, and hydrogen peroxide solutions have been considered. Recently, orthopedic literature has shown that 0.05% Chlorhexidine Gluconate (CHG) lavage has effectively reduced biofilm in artificial joint procedures.
Design
We aimed to investigate a series of patients who underwent revision IPP surgery while utilizing FDA-approved CHG lavage for irrigation and compared the bacterial presence before and after CHG washout. Additionally, Next Generation Sequencing (NGS), a DNA sequencing technology, was used to further identify the pathogens involved.
Findings
Between 2021 to 2023, 48 patients underwent IPP revision surgery for either infectious or noninfectious reasons. During the operation, a section of the capsule tissue surrounding the implanted IPP pump was first taken and sent for cultures. NGS studies were also sent out. After the implant removal, all implant spaces were irrigated and washed out with CHG (two 450-mL bottles). A second tissue culture was then obtained post washout. Of the 48 patients, there were 4 positive bacterial cultures before washout and 13 positive NGS results. Results of the post CHG washout cultures were all negative.
Conclusion
It appears that irrigation with 0.05% Chlorhexidine Gluconate solution is an effective antiseptic that can decrease bacterial presence, and hopefully reduce IPP infections.
References and Resources
- Mulcahy JJ, Köhler TS, Wen L, Wilson SK. Penile implant infection prevention part II: device coatings have changed the game. Int J Impot Res. 2020 Dec;33(8):801-807. doi: 10.1038/s41443-020-0338-1. Epub 2020 Aug 7. PMID: 32770140; PMCID: PMC8776559.
- Wilson SK, Costerton JW. Biofilm and penile prosthesis infections in the era of coated implants: a review. J Sex Med. 2012 Jan;9(1):44-53. doi: 10.1111/j.1743-6109.2011.02428.x. Epub 2011 Sep 22. PMID: 21951338.
- Pineda M, Burnett AL. Penile Prosthesis Infections-A Review of Risk Factors, Prevention, and Treatment. Sex Med Rev. 2016 Oct;4(4):389-398. doi: 10.1016/j.sxmr.2016.03.003. Epub 2016 May 13. PMID: 27872031.
- Selph JP, Carson CC 3rd. Penile prosthesis infection: approaches to prevention and treatment. Urol Clin North Am. 2011 May;38(2):227-35. doi: 10.1016/j.ucl.2011.02.007. PMID: 21621089.
