Journal of Sexual Medicine最新文献

Background: Peri-operative antifungal prophylaxis is increasing, both systemically with intravenous infusion and in dipping solutions for use with hydrophilic penile prosthesis (PP) surfaces.

Aim: In this study, we explore whether amphotericin B or fluconazole decreases vancomycin and gentamicin (VG) antibiotic efficacy when utilized as dips for the hydrophilic PP surface.

Methods: We compared antibiotic activity of PP discs dipped for 3 min in normal saline (NS), 2 mg/mL vancomycin and 160 μg/mL gentamicin in NS, 0.05 mg/mL amphotericin B in VG (VGA), or 2 mg/mL VG constituted in a 20 mg/mL fluconazole in NS solution. Discs were incubated in 1 × 105 CFU/mL of methicillin-sensitive Staphylococcus aureus (MSSA) for 48 h, then adherent bacteria were suspended, plated, and counted. The effect of intraoperative irrigation on the antibacterial activity after a prophylactic dip was assessed by submersion in NS, VG, VGA, or VGF for 2 min followed by incubation with MSSA. Zones of Inhibition (ZOI) were obtained by performing Kirby-Bauer Disc Diffusion Assays against S. aureus, Escherichia coli, and Klebsiella pneumoniae.

Outcomes: Average bacterial counts (CFU/mL) and ZOI (mm) following a series of treatment protocols of PP discs were obtained.

Results: There were significant decreases in bacterial counts in all treatment groups (VG, VGA, and VGF) relative to NS control (P < .001). There were no significant differences in bacterial counts between the treatment groups (P > .05). The greatest decrease in bacterial counts was measured with the VGF/VGF regimen (~6 log, P ≤ .0001). ZOI measurements supported unaltered antibacterial activity across all treatment groups against the different clinical strains.

Clinical implications: Adding antifungals to the antimicrobial dip solution does not diminish the antimicrobial efficacy of VG antibiotics on the hydrophilic PP surface.

Strengths and limitations: This is the first study to demonstrate that the addition of antifungal agents to the antibiotic dip does not diminish the antibacterial efficacy of antimicrobials bound to the hydrophilic surface. Limitations of this study include the use of in vitro studies, which serve as a proxy for in vivo practices and may not be entirely accurate nor translatable in a clinical setting.

Conclusion: The hydrophilic PP surface is versatile. The addition of antifungals to dip and irrigation solutions may provide broader antimicrobial coverage in PP implantation without compromising antibacterial protection, favoring fluconazole over amphotericin B.

Background: Erectile dysfunction refractory to medical therapy is most effectively treated with inflatable penile prosthesis (IPP) implantation, yet infection remains the principal complication. Operating room traffic and airborne exposure have long been suspected contributors, though their impact on prosthetic urology remains unexamined.

Aim: To evaluate whether operating room personnel density, as a surrogate for aerobiome burden, contributes to microbial colonization of IPPs under sterile surgical conditions.

Methods: An ex vivo experimental study was conducted using Rigicon® Infla10X IPP without antibiotic coating. The device was exposed for 45 min to 4 real-world operating room scenarios with varying personnel densities: 4 (standard surgery), 8 (dual-surgeon team), 16 (educational surgery), and 32 (masterclass). The IPP was swabbed at reservoir, pump, and cylinders. Samples underwent DNA extraction, full-length 16S rRNA sequencing (Oxford Nanopore Technologies, Oxford, UK), and quantitative polymerase chain reaction (qPCR). Positive controls (Escherichia coli ATCC 25992) were included.

Outcomes: The primary outcome was microbial colonization of IPPs, defined as detectable microbial DNA by sequencing or qPCR across personnel-density groups.

Results: No microbial DNA was detected in any of the 12 swabbed IPP samples across all groups, whereas the positive controls amplified successfully, confirming methodological validity. Personnel density did not influence microbial colonization, with uniformly negative results in 4-, 8-, 16-, and 32-staff conditions.

Clinical implications: This study demonstrated that operating room personnel density was not associated with increased microbial colonization of IPP via airborne exposure. The results support the safety of educational and live-surgery settings with larger teams when strict sterility protocols are followed.

Strengths and limitations: Strengths include a controlled ex vivo design, simulation of real-world surgical conditions, and comprehensive microbial assessment using next-generation sequencing with qPCR. Limitations include the ex vivo nature of the study, evaluation of a single IPP model without antibiotic coating, and limited exposure duration of 3 hours.

Conclusion: Operating room personnel density did not influence microbial colonization of IPPs under sterile conditions. Airborne exposure may not be a primary factor in the pathogenesis of IPP infection, underscoring the importance of alternative contributors, such as skin-to-implant contact. Further ex vivo and in vivo studies are warranted to clarify infection mechanisms.