title: Revision washout decreases implant capsule tissue culture positivity: a multicenter study.
abstract: OBJECTIVE
  Positive cultures, visible biofilm and confocal micrography confirm bacterial presence on clinically uninfected inflatable penile prostheses at revision surgery. Salvage irrigation has been proved to rescue patients with clinically infected inflatable penile prostheses. Similar washout at revision for noninfectious reasons significantly lowers subsequent infection rates. We investigated a larger series of patients for positive culture rates and evaluated implant capsule tissue culture rates before and after revision washout.
  
  
  METHODS
  At 4 institutions a total of 148 patients with inflatable penile prostheses underwent revision surgery for noninfectious reasons between June 2001 and September 2005. Swab cultures of the fluid around the pump and visible biofilm were obtained. Also, in 65 patients a wedge of tissue from the capsule that forms around the pump was cultured. After implant removal revision washout of the implant spaces was performed and a second wedge of tissue was cultured.
  
  
  RESULTS
  Of the 148 patients 97 (66%) had positive bacterial swab cultures of the fluid around the pump or biofilm. A total of 124 isolates were cultured. Of the 65 implant capsule tissue cultures obtained before washout 28 (43%) were positive for bacteria, while 16 (25%) obtained after revision washout were positive.
  
  
  CONCLUSIONS
  Positive cultures and visible bacterial biofilm are present on clinically uninfected inflatable penile prostheses at revision surgery in most patients. Revision washout appears to decrease the bacterial load on implant capsule tissue at revision surgery of inflatable penile prostheses for noninfectious reasons.
authors.affiliation: Regional Urology, Shreveport, Louisiana, USA. GDHenry@hotmail.com
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.forename: Culley C
authors.initials: CC
authors.lastname: Carson
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wiygul
authors.forename: Chris
authors.initials: C
authors.lastname: Tornehl
authors.forename: Mario A
authors.initials: MA
authors.lastname: Cleves
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Simmons
authors.forename: Craig F
authors.initials: CF
authors.lastname: Donatucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000254:growth & development / Q000302:isolation & purification*; D018441:Biofilms / Q000254:growth & development; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects* / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000517:prevention & control*; D012086:Reoperation; D007507:Therapeutic Irrigation