Manka Madeleine G, Yang David, Andrews Jack, Chalmers Brian, Hebert Kevin, Köhler Tobias S, Trost Landon
Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA.
Department of Orthopedics, Mayo Clinic and Mayo Medical School, Rochester, MN, USA.
Sex Med. 2020 Sep;8(3):422-427. doi: 10.1016/j.esxm.2020.05.010. Epub 2020 Jun 26.
Infection remains a persistent complication of penile prosthesis (PP) surgery. Despite popularity of Mulcahy's PP washout protocol, Betadine has known tissue toxicity.
We evaluated PP infection rate based on the type of intraoperative irrigation used, ½ strength Betadine vs vancomycin/gentamicin.
We reviewed a prospective database of men undergoing primary, revision, and salvage PPs. No other changes to operative or perioperative techniques occurred after the change in irrigation solution. Univariate and logistic regression analyses were used to evaluate differences in infection rate with use of Betadine vs vancomycin/gentamicin irrigation. Potential confounders were reviewed.
The primary outcome was rate of PP infection before and after change of intraoperative irrigation.
From 2014 to 2018, 217 patients underwent PP placement at our institution by a single surgeon; of whom, 21 (9.7%) experienced an infection (primary = 10 [7.1%], revision = 11 [17.19%], salvage = 0 [0%]). Overall, 152 (70%) received irrigation with Betadine and 65 (30%) with Vancomycin/Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (odds ratio [OR]: 4.64, P = .006) and with revision surgery (OR: 2.68, P = .02). Significance of increased infection rate with Betadine was maintained (OR: 9.3; P = .025) after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy.
Changing from intraoperative Betadine to vancomycin/gentamicin solution dramatically reduced infection rates among men undergoing PP placement in both primary and revision cases. We hypothesize that differences in infection rate may relate to the relative toxicity or non-sterile nature of Betadine. Manka MG, Yang D, Andrews J, et al. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020;8:422-427.
感染仍然是阴茎假体（PP）手术的一个持续存在的并发症。尽管Mulcahy的PP冲洗方案很流行，但碘伏已知具有组织毒性。
我们根据术中冲洗所用类型评估PP感染率，即半强度碘伏与万古霉素/庆大霉素的比较。
我们回顾了一个接受初次、翻修和挽救性PP手术的男性前瞻性数据库。在冲洗液改变后，手术或围手术期技术没有其他变化。使用单因素和逻辑回归分析来评估使用碘伏与万古霉素/庆大霉素冲洗时感染率的差异。对潜在的混杂因素进行了审查。
主要结局是术中冲洗改变前后PP感染率。
2014年至2018年，我们机构有217例患者由一名外科医生进行了PP植入；其中，21例（9.7%）发生感染（初次手术 = 10例[7.1%]，翻修手术 = 11例[17.19%]，挽救性手术 = 0例[0%]）。总体而言，152例（70%）接受了碘伏冲洗，65例（30%）接受了万古霉素/庆大霉素冲洗。单因素分析显示，碘伏冲洗（优势比[OR]：4.64，P = 0.006）和翻修手术（OR：2.68，P = 0.02）的感染率显著增加。在控制了年龄、体重指数、Charlson合并症指数、吸烟、糖尿病、初次手术与翻修/挽救性手术、既往阴茎手术、异位储器的使用以及辅助性龟头固定术后，碘伏导致感染率增加的显著性仍然存在（OR：9.3；P = 0.025）。
在初次和翻修病例中，将术中碘伏改为万古霉素/庆大霉素溶液可显著降低接受PP植入男性的感染率。我们推测感染率的差异可能与碘伏的相对毒性或非无菌性质有关。Manka MG、Yang D、Andrews J等。术中使用碘伏冲洗与阴茎假体感染可能性增加9倍相关：一项回顾性病例对照研究的结果。性医学2020；8：422 - 427。
