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198 A Retrospective Analysis of the Influence of High Dose Gentamicin on IPP Infection Rates
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study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 198 A RETROSPECTIVE ANALYSIS OF THE INFLUENCE OF HIGH DOSE GENTAMICIN ON IPP INFECTION RATES Gross, M.S.1; Wallen, J.J.2; Madiraju, S.K.3; Tayon, K.G.3; Munarriz, R.M.4; Perito, P.E.5 1 Dartmouth-Hitchcock Medical Center, USA; 2USF Morsani School of Medicine, USA; 3The Charles E. Schmidt College of Medicine of FAU, USA; 4Boston University Medical Center, USA; 5 Perito Urology, USA Objectives: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements and adoption of antibiotic prophylaxis guidelines. This study compares inflatable penile prosthesis (IPP) infections in patients who received standard dose, non-weight-based (NWB) intravenous gentamicin preoperatively versus high dose, weightbased (HD) intravenous gentamicin as antibiotic prophylaxis. Material and Methods: This study is a retrospective cohort comparison of 139 consecutive IPP patients who underwent implantation by a single surgeon between November 2014 and April 2015 using 1gram of IV vancomycin and 80 mg NWB IV gentamicin. These patients were matched with 184 consecutive IPP patients who underwent implantation between May 2015 and December 2015 using 1 gram of IV vancomycin and HD IV gentamicin dosed for 5 mg/kg of actual body weight. Patient data were compiled after extensive review of operative reports, inpatient notes, consult notes, and follow-up visits. Age, comorbidities, overall health status, IPP manufacturer, and oral antibiotics received 2 days prior to surgery were similar between the two cohort groups. Surgical technique and antibiotic irrigation were also indistinguishable between the cohorts. We performed univariate statistical analysis to determine significant predictors of infectious complications. Results: The NWB patients suffered four postoperative IPP infections (2.8%). Three of four implants were in patients who had undergone primary implantation. One implant patient in the NWB gentamicin cohort had an infection after device removal and replacement. Two of these four patients underwent successful salvage with malleable implants, the rest underwent device explant. In contrast, none of the patients (0.0%) in the HD gentamicin cohort had a postoperative infection. The HD gentamicin cohort included 17 removal and replacement patients. Conclusions: An antibiotic prophylaxis regimen consisting of high dose, weight-based gentamicin along with vancomycin reduced the rate of infectious complications in our series of patients undergoing IPP implantation. Further prospective studies are needed to compare NWB and HD gentamicin dosing to determine the utility of this regimen in primary implant and revision implant cases.
SMSNA Abstracts
Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 199 A RETROSPECTIVE ANALYSIS OF RISK FACTORS FOR IPP RESERVOIR ENTRY INTO THE PERITONEUM AFTER POSTERIOR TO TRANSVERSALIS FASCIA PLACEMENT Gross, M.S.1; Garber, B.B.2; Stember, D.S.3; Perito, P.E.4 1 Dartmouth-Hitchcock Medical Center, USA; 2Hahnemann University Hospital, USA; 3Mount Sinai Hospital, USA; 4Perito Urology, USA Objectives: Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with erectile dysfunction (ED) refractory to medical management. We have previously demonstrated a protocol for alternative IPP reservoir placement posterior to the abdominal wall musculature, which was shown to be a safe location with extremely low complication rates. This is in contrast to traditional placement in the retropubic space of Retzius, which can result in bowel, bladder and vascular injury. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after placement posterior to the abdominal wall musculature to further increase the safety of this approach. Material and Methods: We retrospectively reviewed our patients with peritoneal entry of the reservoir after posterior to transversalis fascia (PTF) placement during virgin IPP cases performed by a single surgeon. Our goal was to assess common inherent patient and surgical factors that resulted in this complication in order to develop a management algorithm to prevent future occurrence during alternative reservoir placement. We reviewed preoperative patient health characteristics, history of prior pelvic surgery, intraoperative documentation, postoperative follow-up, complication presentation, and imaging for this group. Follow-up visit data was available for up to 24 months after surgery at regular intervals. We were further able to assess long-term outcomes from this complication, including resolution of peritoneal reservoir entry and eventual IPP replacement. Results: Peritoneal reservoir entry was identified in two patients. These patients were noted to be thin (mean BMI 18.5) current or former smokers, without peritoneal surgical histories. Peritoneal entry was identified early after reservoir placement. Neither patient suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up. Conclusions: PTF reservoir placement is a safe, simple and effective method of avoiding vascular and bladder injury during IPP implantation. Peritoneal entry of the reservoir occurs very rarely, and in our series occurred in two patients with distinct physical and pathological features. We recommend early identification of similar patients, with anterior to transversalis fascia placement to prevent peritoneal entry. J Sex Med 2017;14:e1ee104
study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 198 A RETROSPECTIVE ANALYSIS OF THE INFLUENCE OF HIGH DOSE GENTAMICIN ON IPP INFECTION RATES Gross, M.S.1; Wallen, J.J.2; Madiraju, S.K.3; Tayon, K.G.3; Munarriz, R.M.4; Perito, P.E.5 1 Dartmouth-Hitchcock Medical Center, USA; 2USF Morsani School of Medicine, USA; 3The Charles E. Schmidt College of Medicine of FAU, USA; 4Boston University Medical Center, USA; 5 Perito Urology, USA Objectives: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements and adoption of antibiotic prophylaxis guidelines. This study compares inflatable penile prosthesis (IPP) infections in patients who received standard dose, non-weight-based (NWB) intravenous gentamicin preoperatively versus high dose, weightbased (HD) intravenous gentamicin as antibiotic prophylaxis. Material and Methods: This study is a retrospective cohort comparison of 139 consecutive IPP patients who underwent implantation by a single surgeon between November 2014 and April 2015 using 1gram of IV vancomycin and 80 mg NWB IV gentamicin. These patients were matched with 184 consecutive IPP patients who underwent implantation between May 2015 and December 2015 using 1 gram of IV vancomycin and HD IV gentamicin dosed for 5 mg/kg of actual body weight. Patient data were compiled after extensive review of operative reports, inpatient notes, consult notes, and follow-up visits. Age, comorbidities, overall health status, IPP manufacturer, and oral antibiotics received 2 days prior to surgery were similar between the two cohort groups. Surgical technique and antibiotic irrigation were also indistinguishable between the cohorts. We performed univariate statistical analysis to determine significant predictors of infectious complications. Results: The NWB patients suffered four postoperative IPP infections (2.8%). Three of four implants were in patients who had undergone primary implantation. One implant patient in the NWB gentamicin cohort had an infection after device removal and replacement. Two of these four patients underwent successful salvage with malleable implants, the rest underwent device explant. In contrast, none of the patients (0.0%) in the HD gentamicin cohort had a postoperative infection. The HD gentamicin cohort included 17 removal and replacement patients. Conclusions: An antibiotic prophylaxis regimen consisting of high dose, weight-based gentamicin along with vancomycin reduced the rate of infectious complications in our series of patients undergoing IPP implantation. Further prospective studies are needed to compare NWB and HD gentamicin dosing to determine the utility of this regimen in primary implant and revision implant cases.
SMSNA Abstracts
Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 199 A RETROSPECTIVE ANALYSIS OF RISK FACTORS FOR IPP RESERVOIR ENTRY INTO THE PERITONEUM AFTER POSTERIOR TO TRANSVERSALIS FASCIA PLACEMENT Gross, M.S.1; Garber, B.B.2; Stember, D.S.3; Perito, P.E.4 1 Dartmouth-Hitchcock Medical Center, USA; 2Hahnemann University Hospital, USA; 3Mount Sinai Hospital, USA; 4Perito Urology, USA Objectives: Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with erectile dysfunction (ED) refractory to medical management. We have previously demonstrated a protocol for alternative IPP reservoir placement posterior to the abdominal wall musculature, which was shown to be a safe location with extremely low complication rates. This is in contrast to traditional placement in the retropubic space of Retzius, which can result in bowel, bladder and vascular injury. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after placement posterior to the abdominal wall musculature to further increase the safety of this approach. Material and Methods: We retrospectively reviewed our patients with peritoneal entry of the reservoir after posterior to transversalis fascia (PTF) placement during virgin IPP cases performed by a single surgeon. Our goal was to assess common inherent patient and surgical factors that resulted in this complication in order to develop a management algorithm to prevent future occurrence during alternative reservoir placement. We reviewed preoperative patient health characteristics, history of prior pelvic surgery, intraoperative documentation, postoperative follow-up, complication presentation, and imaging for this group. Follow-up visit data was available for up to 24 months after surgery at regular intervals. We were further able to assess long-term outcomes from this complication, including resolution of peritoneal reservoir entry and eventual IPP replacement. Results: Peritoneal reservoir entry was identified in two patients. These patients were noted to be thin (mean BMI 18.5) current or former smokers, without peritoneal surgical histories. Peritoneal entry was identified early after reservoir placement. Neither patient suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up. Conclusions: PTF reservoir placement is a safe, simple and effective method of avoiding vascular and bladder injury during IPP implantation. Peritoneal entry of the reservoir occurs very rarely, and in our series occurred in two patients with distinct physical and pathological features. We recommend early identification of similar patients, with anterior to transversalis fascia placement to prevent peritoneal entry. J Sex Med 2017;14:e1ee104