rifampin and Erectile-Dysfunction

Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week and presents in the form of frank clinical features (pain, erythema, penile discharge); highly virulent bacteria are isolated, such as Staphylococcus aureus. Late sepsis occurs after an interval of several weeks to several months with less specific clinical features; Staphylococcus epidermidis is isolated in more than 50% of cases. Conventional treatment of these infections consists of antibiotics adapted to the local flora and removal of the prosthesis, sometimes followed by deferred reimplantation. Prosthetic material salvage procedures are now proposed. Patient-related risk factors for infection include diabetes, urinary tract infection and immunodepression, while procedure-related risk factors include the length of hospital stay, poor operative technique, prolonged operating time and iatrogenic urethral injuries. Prevention of sepsis of penile prostheses is based on prevention of these risk factors and prophylactic antibiotics or prolonged antibiotic therapy.

Topics: Bacterial Infections; Diabetes Complications; Drug Therapy, Combination; Erectile Dysfunction; Humans; Male; Penile Prosthesis; Penis; Postoperative Complications; Rifampin; Risk Factors; Vancomycin

Although some studies suggest that most infections associated with inflatable penile prosthesis implantation develop within year 1 after surgery, device related infections have been reported 5 years after implantation or later and the infection risk with time is not well characterized. We previously reported a statistically significantly lower infection rate for original inflatable penile prostheses impregnated with antibiotic treatment with minocycline and rifampin vs nonimpregnated inflatable penile prostheses at 1-year followup. Long-term data are now available on infection revision after initial implantation of antibiotic impregnated vs nonimpregnated prostheses.. We retrospectively reviewed patient information forms voluntarily filed with the manufacturer after the initial implantation of more than 39,000 inflatable penile prostheses to compare the revision rate due to infection for antibiotic impregnated vs nonimpregnated implants between May 1, 2001 and December 31, 2008. Life table analysis was used to evaluate device survival from revision surgery.. On life table survival analysis initial revision events due to infection were significantly less common in the impregnated vs the nonimpregnated group (log rank p <0.0001). At up to 7.7 years of followup 1.1% of 35,737 vs 2.5% of 3,268 men with impregnated vs nonimpregnated implants underwent initial revision due to infection.. To our knowledge this long-term outcome analysis provides the first substantial clinical evidence of a decrease in costly infection related revision using an antibiotic impregnated inflatable penile prosthesis.

Topics: Anti-Bacterial Agents; Chi-Square Distribution; Cohort Studies; Drug Delivery Systems; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Penile Prosthesis; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Prosthesis-Related Infections; Reference Values; Reoperation; Retrospective Studies; Rifampin; Risk Assessment; Treatment Outcome

Topics: Anti-Bacterial Agents; Drug Delivery Systems; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Penile Prosthesis; Prosthesis Design; Prosthesis Implantation; Prosthesis-Related Infections; Reference Values; Rifampin; Time Factors; Treatment Outcome

We present 6 patients in whom prosthetic failure occurred because of sepsis owing to Staphylococcus epidermidis. Such failure occurs in grafts in other areas and is caused by the high resistance of the organism to conventional antibacterial measures. Therapy with appropriate antibiotics, that is aminoglycosides, vancomycin and rifampin, and the need for an early operation are stressed.

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Diabetes Complications; Drug Resistance, Microbial; Erectile Dysfunction; Humans; Male; Middle Aged; Penis; Prostheses and Implants; Prosthesis Failure; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Testis; Vancomycin