Presentation Authors: Madeleine Manka*, Kevin Hebert, Nicole Dodge, David Yang, Tobias Kohler, Landon Trost, Rochester, MN
Introduction: Infection remains a persistent complication of inflatable penile prosthesis (IPP) surgery. Despite popularity of the Mulcahy IPP washout protocol, Betadine has known tissue toxicity. We evaluated IPP infection rate based on the type of intraoperative irrigation utilized, Betadine (10%) versus Vancomycin / Gentamicin, and other factors which may affect infection rate.
Methods: We reviewed a consecutive series from a detailed, prospective database of men undergoing primary, revision, and salvage penile prostheses at our institution. The primary outcome was rate of IPP infection prior to and following change of intra-operative irrigation. No other changes to operative or perioperative techniques occurred following the change in irrigation solution. Univariate and regression analyses were used to evaluate differences in infection rate with use of Betadine versus Vancomycin / Gentamicin irrigation. Multiple potential confounders were reviewed including patient demographics, comorbidities, type of surgery (primary, revision, salvage), prior penile surgery, and adjunctive techniques.
Results: A total of 217 patients (mean age 65 years) underwent IPP placement at our institution from January 2014 to April 2018, of whom 21 (9.7%) experienced an infection (primary=10 (7.1%), revision=11 (17.19%), salvage=0 (0%)). Overall, 152 (70%) received irrigation with Betadine compared to 65 (30%) with Vancomycin / Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (OR 4.64, p=0.006) and with revision surgery (OR 2.68, p = 0.02). Significance of increased infection rate with Betadine was maintained (OR 9.3; p=0.025) after controlling for age, BMI, Charleson Comorbidity Index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy.
Conclusions: Changing from intra-operative Betadine to Vancomycin / Gentamicin solution dramatically reduced infection rates among men undergoing IPP placement in both primary and revision cases. We hypothesize that differences in infection rate may relate to the relative toxicity of Betadine to intra-scrotal tissues and/or non-sterile nature of Betadine.