Malleable Implanted (Tactra 27X13)

[LastHope]

......Have there been advances in implant material that prevent the formation of biofilm?

The material (coating) advancements have certainly contributed to about 50% reduction but not 100% prevention. More surface area, more biofilms.

2018 Dec Translational Andrology and Urology journal

Penile prosthesis biofilm formation and emerging therapies against them

Advancements in implant technology and antiseptic device preparation have decreased infection rates to approximately 1–3% in recent years (13). The two producers of 3-piece IPPs in the US have developed infection-retardant coatings on their implants to reduce infection rates. Boston Scientific (Marlborough, MA) uses a coating of rifampin and minocycline called InhibiZone®. Coloplast Corporation (Humlebaek, Denmark) coats its devices with polyvinylpyrrolidone, a hydrophilic substance that absorbs the antibiotics the IPP is bathed in immediately prior to implantation (10). In a large observational study comparing the infection rates of 1,944 non-coated to 2,261 InhibiZone®-coated IPPs, Carson reported a 50% reduction in infections at 180 days in the coated group (14).

...To further improve outcomes and the risk of infection, many surgeons have also adopted the “no touch” technique during procedures, as popularized by Eid (15). In this method, the implant, the instruments, and the surgeon’s hands never make contact with the patient’s skin during the operation. When paired with infection retardant coated IPPs, this “no touch” technique further reduces the rate of infection to 0.46%

Despite these advances in technology and technique, infections continue to occur. In a recent multicenter investigation of organisms cultured at the time of IPP salvage or explant, 204 organisms were identified (17). The three most prevalent organisms cultured were Escherichia coli (18.3%), followed by coagulase-negative Staphylococcus species (15%), and Candida species (11.1%).

[ready2go]

11mm rod - 1.36 " girth x 2 =2.72 "
13 mm rod -1.60 " girth x 2 =3.2 "
15 mm rod -1.85 " girth x 2 = 3.7 '
not including what its inserted into
. 48" more girth wth a 13 mm rods than 11 mm
nearly an inch [.98] from a 15 mm rod to an 11 mm rod x2

Your girth comes from your tunica albuginea, not from the rods.

Oh get real . There is a reason there is different size rods .
And the tunica albuginea is destroyed by the dilators used when implanting the malleable .
The reason for the lose of girth
No engorgement from blood flow

[ready2go]

11mm rod - 1.36 " girth x 2 =2.72 "
13 mm rod -1.60 " girth x 2 =3.2 "
15 mm rod -1.85 " girth x 2 = 3.7 '
not including what its inserted into
. 48" more girth wth a 13 mm rods than 11 mm
nearly an inch [.98] from a 15 mm rod to an 11 mm rod x2

Your girth comes from your tunica albuginea, not from the rods.

"During an erection, the tunica albuginea expands and increases the second moment of area of the corpus cavernosum ... "
No engorgement no added girth
What ever flesh is there adds to the size of the rods
A larger diameter rod will add girth
A 9mm rod will not give the same girth of a 15 mm rod

[nuance]

......Have there been advances in implant material that prevent the formation of biofilm?

The material (coating) advancements have certainly contributed to about 50% reduction but not 100% prevention. More surface area, more biofilms.

2018 Dec Translational Andrology and Urology journal

Penile prosthesis biofilm formation and emerging therapies against them

Advancements in implant technology and antiseptic device preparation have decreased infection rates to approximately 1–3% in recent years (13). The two producers of 3-piece IPPs in the US have developed infection-retardant coatings on their implants to reduce infection rates. Boston Scientific (Marlborough, MA) uses a coating of rifampin and minocycline called InhibiZone®. Coloplast Corporation (Humlebaek, Denmark) coats its devices with polyvinylpyrrolidone, a hydrophilic substance that absorbs the antibiotics the IPP is bathed in immediately prior to implantation (10). In a large observational study comparing the infection rates of 1,944 non-coated to 2,261 InhibiZone®-coated IPPs, Carson reported a 50% reduction in infections at 180 days in the coated group (14).

...To further improve outcomes and the risk of infection, many surgeons have also adopted the “no touch” technique during procedures, as popularized by Eid (15). In this method, the implant, the instruments, and the surgeon’s hands never make contact with the patient’s skin during the operation. When paired with infection retardant coated IPPs, this “no touch” technique further reduces the rate of infection to 0.46%

Despite these advances in technology and technique, infections continue to occur. In a recent multicenter investigation of organisms cultured at the time of IPP salvage or explant, 204 organisms were identified (17). The three most prevalent organisms cultured were Escherichia coli (18.3%), followed by coagulase-negative Staphylococcus species (15%), and Candida species (11.1%).

Thank you, this is very useful. I hope they prescribe antibiotics for these 3 variants. I guess they need to act before biofilm is formed. Does Inhibizone protect against all these ?

Do we know if rupture of biofilm can lead to infection many years later or is the body able to combat it?

[LastHope]

Thank you, this is very useful. I hope they prescribe antibiotics for these 3 variants. I guess they need to act before biofilm is formed. Does Inhibizone protect against all these ?

Do we know if rupture of biofilm can lead to infection many years later or is the body able to combat it?

Oral antibiotics such as Bactrim can be used prophylactically and also to treat superficial incision infections.

Rifampin + Minocycline in Inhibizone (AMS IPP coating) can help fight E.coli and CoNS before biofilms colonies are formed.

Tactra MPP doesn't have inhibizone coating yet (just FYI..).

Candida is a fungal infection and requires antifungals like Fluconazole if it occurs superficially on incision site.

Surgeons can include antifungals to their antibiotic preparations. Some use a solution called Irrisept on implants that comes with hydrophilic coating (Coloplast/Rigicon). Irrisept helps fight bacteria, virus and fungi.

Yes, biofilm rupture not fun. Biofilms are 1000 times more resistant to antibiotics compared to free floating bacteria.

56% of implant infections manifest in 1-7 months
36% of them in 7-12 months.
2.6% after 5 years.

This stat is from a 1987 study, so please take it with a grain of salt!

[easymoney]

My surgeon told me infection can pop up as long as 3 yrs after the surgery which I found to be amazing ..

[nuance]

What does biofilm rupture even look like? Biofilm is formed to protect against immune system so is it possible if biofilm ruptures, immune system will handle it?

[LastHope]

My surgeon told me infection can pop up as long as 3 yrs after the surgery which I found to be amazing ..

Thanks, Easymoney. This is good to know. It should reflect the latest consensus compared to some 1987 study with uncoated implants and no popularity of no-touch techniques.

[LastHope]

What does biofilm rupture even look like? Biofilm is formed to protect against immune system so is it possible if biofilm ruptures, immune system will handle it?

It looks like the image posted.

No guarantees with the immune system. Patients may have multiple comorbidities and this is highly subjective. Immune system can handle or it can get overwhelmed. Dispersed bacteria can also form new biofilms.

[Fidelio]

This is very helpful. Thank you, Fidelio. I have listed them for easy reference, organized in two ways: one sorted by year of practice start and the other in increasing order of cost. I have also added current COE status, as it means a "minimum" volume of 25-30 implants/year for a particular brand.

Thanks, this graphic is very helpful. We could open another thread for that as there are some notable names amongst these guys and their patients might not even be aware they offer these 'surgeon packages'.