Post-operative antibiotics following placement of a penile prosthesis
Editorial

Post-operative antibiotics following placement of a penile prosthesis

Alex Tatem1, Jason R. Kovac2

1Department of Urology, Indiana University, Indianapolis, Indiana, USA; 2Men’s Health Center, Indianapolis, Indiana, USA

Correspondence to: Dr. Jason R. Kovac, MD, PhD, FACS, FRCSC. Men’s Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260, USA. Email: jkovac@urologyin.com.

Comment on: Palma-Zamora I, Sood A, Dabaja AA. 30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation. Transl Androl Urol 2017;6:S767-73.


Submitted Nov 11, 2017. Accepted for publication Nov 13, 2017.

doi: 10.21037/tau.2017.11.14


One of the most devastating complications that can occur following a penile prosthesis is infectious in nature (1,2). Consequently, both proper patient selection and risk management are essential for prosthetic surgeons. In a recent paper by Palma-Zamora et al. (1) published in the current issue of Translational Andrology and Urology, the authors present data discussing the short-term (30-day) adverse outcomes that can occur post placement of a penile prosthesis. The authors identified an overall 30-day complication rate of 11%; of which 45% were infectious in etiology (1). Diabetes was present in 29% of patients (1) and although there is some debate regarding the importance of hemoglobin A1c in diabetic patients undergoing prosthesis placement, optimizing peri-operative glucose control for all diabetic patients is essential in reducing the risk of infectious complications (3,4). Given the significant consequences of infection, a brief discussion regarding post-operative antibiotic usage is warranted.

In a 2013 consensus statement of 16 top prosthetic surgeons, anywhere from 5–14 days of post-operative oral antibiotics was preferred (5). A multitude of different oral antibiotics were used including quinolones, cephalosporins, penicillins and sulfa drugs (5). In geographic regions where methicillin-resistant Staphylococcus aureus (MRSA) was prevalent, the consensus was to use trimethoprim-sulfamethoxazole (Bactrim) or, in cases of sulfa drug allergy, doxycycline (5). Unfortunately, given the current state of research and methodological challenges, expert opinion is the best level of evidence available. While no randomized controlled trials to support this practice, recent case reports and small retrospective studies have found success in managing even local infections with conservative measures that include oral antibiotics (6,7). At the present time, although further study is required, the use of post-operative prophylactic antibiotic usage is justified.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Palma-Zamora I, Sood A, Dabaja AA. 30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation. Transl Androl Urol 2017;6:S767-73.
  2. Pineda M, Burnett AL. Penile Prosthesis Infections-A Review of Risk Factors, Prevention, and Treatment. Sex Med Rev 2016;4:389-98. [Crossref] [PubMed]
  3. Wilson SK, Carson CC, Cleves MA, et al. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol 1998;159:1537-9; discussion 1539-40. [Crossref] [PubMed]
  4. Martin ET, Kaye KS, Knott C, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2016;37:88-99. [Crossref] [PubMed]
  5. Darouiche RO, Bella AJ, Boone TB, et al. North American consensus document on infection of penile prostheses. Urology 2013;82:937-42. [Crossref] [PubMed]
  6. Habous M, Farag M, Williamson B, et al. Conservative Therapy is an Effective Option in Patients With Localized Infection After Penile Implant Surgery. J Sex Med 2016;13:972-6. [Crossref] [PubMed]
  7. Luján S, Rogel R, Broseta E, et al. Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery. Sex Med 2016;4:e255-8. [Crossref] [PubMed]
Cite this article as: Tatem A, Kovac JR. Post-operative antibiotics following placement of a penile prosthesis. Transl Androl Urol 2017;6(Suppl 5):S774-S775. doi: 10.21037/tau.2017.11.14