Contemporary Microbial Profile of Artificial Urinary Sphincter Erosions.

Abstract

Introduction: There is a dearth of data for artificial urinary sphincter (AUS) erosions after the introduction of InhibiZone-coated devices in 2008. We aim to identify common organisms associated with noninfected and infected AUS device erosions.

Methods: We reviewed our prospectively collected, institutionally approved quality improvement database of AUS implantations, removals, or revisions performed at our facility. Devices implanted after 2008 that subsequently eroded were included for review. Erosion was confirmed cystoscopically in all cases. Urine cultures and intraoperative cultures (tissue, aspirate, or swab) were reviewed. Descriptive analyses of clinical and culture data were performed.

Results: We performed 1104 AUS cases between 2008 and 2022 and identified 80 (7.2%) erosions of InhibiZone-coated AUS devices in 67 patients. Median time to erosion was 10.5 months (IQR 3-29). Forty-nine patients (73%) received prior pelvic radiation. Sixty-seven (84%) erosion cases had urine cultures, and 36 (45%) had intraoperative cultures available for review. Of the 47 (70%) positive urine cultures, the most common results were mixed flora (36%), Escherichia coli (7%), and Klebsiella (7%). Top isolates from the 26 (72%) positive intraoperative cultures were Staphylococcus species (14%) and Pseudomonas (14%), followed by E coli (11%), Candida (11%), and Klebsiella (11%). Positive intraoperative cultures isolated more gram-negative organisms (47%) than gram-positive organisms (38%).

Conclusions: InhibiZone-coated AUS device erosions were associated with a wide variety of organisms, including gram-positive, gram-negative, and fungal species. This can help guide modern antimicrobial prophylaxis practices and empiric treatment pathways in the eroded patient.