Antibiotic stewardship is now a priority for the urologic community. Perioperative antibiotic use at the time of inflatable penile prosthesis (IPP) insertion has become a topic of interest.
To review the literature available to inform the practice of antibiotic administration before, during, and after IPP insertion.
We performed a literature review based on a search for the terms "Antibiotics" and "Penile Prosthesis" in the PubMed database. Manuscripts were individually reviewed for relevance to the administration of antibiotics in conjunction with IPP insertion. Best practice statements and guidelines from stakeholder organizations were also reviewed.
The benefits of preoperative antibiotic prophylaxis have been well studied in the orthopedic and general surgery literature, but a dearth of studies are available in the specific context of IPP insertion. High-quality retrospective studies have demonstrated reduced infection rates with the use of antibiotic-impregnated or antibiotic-coated IPPs. Limited research on the use of postoperative antibiotics after IPP insertion has actually not demonstrated a benefit from this very common practice. Indeed, the broader surgical literature suggests a net harm from continued postoperative antibiosis. A 2017 guideline recommendation from the Center for Disease Control and Prevention states that additional prophylactic antibiotics should not be administered after procedures deemed clean or clean-contaminated.
The benefits of single-dose preoperative antibiotics and the use of antibiotic-impregnated or antibiotic-coated IPPs are well established. Postoperatively, the available IPP and broader surgical literature does not reflect a benefit from the administration of additional antibiotics and demonstrates higher rates of antibiotic-associated adverse events and the emergence of drug resistance. In average-risk patients undergoing IPP insertion, contemporary data suggest that it is safe for postoperative antibiotics to be withheld. Dropkin BM, Kaufman MR. Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review. J Sex Med 2020;XX:XXX-XXX.
Sexual medicine reviews. 2020 Jul 03 [Epub ahead of print]
Benjamin M Dropkin, Melissa R Kaufman
Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ., Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.