Tissue ingrowth in penile implants and its effect on repeat penile surgery.

Penile implant malfunction is usually treated by removal of the original malfunctioning implant followed by replacement with a new device. During replacement, the original implant can be explanted without any difficulty, as it is not adherent to the surrounding tissue. Herein, we describe two cases of tissue ingrowth into the implant that produced difficulty during explantation and suggest ways in which this condition can be managed.

Expression of cAMP-responsive element modulator (CREM) in rat testes following chronic cocaine administration.

OBJECTIVE: c-AMP-responsive element modulator (CREM), one of the nuclear factors involved in the regulation of gene expression by cAMP, has an important role in spermatogenesis. Our recent study has shown that chronic administration of cocaine to male rats results in disruption of spermatogenesis, including reduction of germ cells. As a further step toward understanding this process, we have studied the role of CREM in cocaine-induced testicular damage. MATERIALS AND METHODS: Sprague-Dawley rats were administered cocaine hydrochloride subcutaneously daily for 90 days. Control animals received equal volumes of normal saline daily for 90 days. Testes were removed after 15, 30, 90 days of cocaine administration. Total RNA was extracted from the testes and subjected to RT-PCR. Testicular tissue was also homogenized in a lysis buffer, and Western blotting was performed using anti-CREM antibody. RESULTS: RT-PCR analysis detected a single fragment of approximately 520 base pairs (bp) in control testes at all time points. The cocaine-treated testes showed reduced expression of CREM fragment. Western blot analysis using CREM antibodies confirmed the RNA data. There were reduced CREM proteins in the cocaine-treated testes compared with controls. CONCLUSIONS: The CREM gene is essential for spermatogenesis. Our results indicate that the reduction in testicular CREM expression may be one of the mechanisms responsible for disruption or impairment of spermatogenesis in the testes following chronic cocaine administration.

Role of mitochondrial cytochrome c in cocaine-induced apoptosis in rat testes.

OBJECTIVES: We have previously demonstrated that cocaine exposure leads to apoptosis in rat testes. To understand further the mechanism of cocaine-induced testicular damage, we studied the effect of cocaine on cytochrome c release from the mitochondria. We also determined the caspase 3, caspase 8, and caspase 9 activities in rat testes after chronic cocaine exposure. METHODS: Thirty-day-old male Sprague-Dawley rats received cocaine hydrochloride or equal volumes of normal saline subcutaneously daily for 90 days. The testes were removed at 15, 30, and 90 days of cocaine or saline administration. Mitochondria and cytosolic fractions from testes were isolated. Western blotting was performed in both fractions using anti-cytochrome c antibody. Caspase 3, caspase 8, and caspase 9 activities were determined by fluorometric assay. RESULTS: The expression of cytochrome c protein in the cytosolic fraction was increased on day 15 and persisted for up to 90 days after cocaine injection compared with controls. However, the expression of cytochrome c in testes was decreased in the mitochondria fraction on days 15, 30, and 90 after cocaine injections compared with the corresponding controls. The caspase activity study showed caspase 3 and caspase 9 activities increased in cocaine-treated testes at each point of the study compared with the corresponding controls. However, the caspase 8 activity in cocaine-treated testes did not change significantly at each point of the study compared with the corresponding controls. CONCLUSIONS: Our results suggest that the release of cytochrome c from mitochondria and its subsequent activation of caspase 9 and caspase 3 in testes play a key role in cocaine-induced germ cell apoptosis. Our findings also indicate that cocaine-induced testicular germ cell apoptosis in rats is at least initiated through a mitochondria-associated pathway.

Cigarette smoking induces apoptosis in rat testis.

In a previous studywe demonstrated the deleterious effect of cigarette smoke on spermatogenesis in the testis of peripubertal Sprague-Dawley rats. In this study we investigated the development of apoptosis as a possible contributing factor to the pathogenic mechanism underlying these effects. Peripubertal rats were exposed to cigarette smoke with the Walton Horizontal Smoking Machine. Similarly, age-matched control rats were exposed to room air with the smoking machine. Rats from both groups were sacrificed after 45 days of treatment and the testes were removed. Testes were stained utilizing the terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) staining technique. DNA fragmentation was further evaluated using gelectrophoresis. There was a significant increase in the incidence of apoptosis in the treated group compared to the control group as demonstrated by the larger amount of tubules containing > or = 3apoptotic bodies in the smoke-exposed group, that is, 36% versus 14% in the control group (p < 0.05). Agarose gel electrophoresis demonstrated the DNA ladder in the treated group but not in the control animals. In conclusion, chronic cigarette smoke induces apoptosis in the rat testis. Apoptosis may be one of the pathogenic mechanisms responsible for defective spermatogenesis in the rat following chronic cigarette smoking.

ÚItimos avances en la cirugía implante del peneano / Recent developments in penile implant surgery

A pesar de los múltiples tratamientos disponibles hoy para la disfunción eréctil , la prótesis peneana inflable multicompuesta de 3 piezas ha sobrevivido la prueba del tiempo, llegando a ser la modalidad con mayor tasa de éxito y de satisfacción por parte del paciente, debido tanto a la fiabilidad y calidad de la erección como a la consecución del estado de flacidez. En esta revisión, tras una breve visita a los orígenes históticos de la cirugía de la prótesis peneana, describimos meticulosamente comose implanta la prótesis y los pasos técnicos que permiten conseguir la operación con éxito. Finalmente, proporcionaremos algunas reflexiones sobre los últimos desarrollos en este campo, que incluyen los implantes de base estrecha, el reservorio valvular sin escape y los implantes cubiertos de antibiótico (AU)

Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism.

PURPOSE: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. MATERIALS AND METHODS: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. RESULTS: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. CONCLUSIONS: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi-institutional trials to objectively assess safety and efficacy in the various treatment modalities.

Morphometric analysis of rat testis following chronic exposure to cigarette smoke.

PURPOSE: To assess the effect of chronic exposure to cigarette smoke on spermatogenesis in Sprague-Dawley rats. MATERIALS AND METHODS: Twenty 5-day-old Sprague-Dawley rats were exposed daily to cigarette smoke by the Walton smoking machine for a period of 15, 30, and 45 days. Age-matched Sprague-Dawley rats exposed to room air with the smoking machine served as controls. Rats were sacrificed from each group at 15, 30, and 45 days and the testes were removed. Fifty seminiferous tubules were assessed in each group. Morphometric and histopathologic analyses of the testes were carried out. The following parameters were studied: (1) Number of germ cells (step 7 spermatids), (2) seminiferous tubule diameter, (3) height of germinal epithelium, (4) presence of degenerating or sloughed cells, (5) failure of release of spermatids into the tubular lumen, and (6) degeneration of Leydig cells. Statistical analysis was performed using ANOVA followed by the t test. RESULTS: There was a significant decrease in the germ cell count (step 7 spermatids) in the rats exposed to cigarette smoke for 30 days (93.19 versus 98.15 step 7 spermatids in the control animals (p < 0.001). This decrease persisted in the rats exposed to cigarette smoke for 45 days (82.47 versus 103.01 step 7 spermatids in control animals, p < 0.001). The mean seminiferous tubule diameter was significantly reduced only in the rats exposed to cigarette smoke for 45 days (0.283 microm versus 0.299 microm in the control animals, p < 0.001). There was no significant difference in the height of the germinal epithelium, and no degenerating cells were noted in either group. CONCLUSIONS: Cigarette smoke adversely affects spermatogenesis in pubertal Sprague-Dawley rats.

Chronic cigarette smoking induces an oxidantantioxidant imbalance in the testis.

OBJECTIVES: We have previously demonstrated the harmful effect of chronic inhalation of cigarette smoke on the testis in Sprague-Dawley rats. The aim of the present study was to investigate the role of free oxygen radicals and reactive oxygen species in inducing testicular damage in Sprague-Dawley rats following exposure to cigarette smoke. MATERIALS AND METHODS: Sprague-Dawley rats, 25 days old, were exposed daily to cigarette smoke by the Walton smoking machine for a period of 15, 30, and 45 days. Age-matched Sprague-Dawley rats were exposed to room air with the smoking machine and served as controls. Rats were sacrificed from each group at 15, 30, and 45 days and the testes were removed. The testicular tissue levels of glutathione and lipid peroxidation product malonaldehyde (MDA) were measured colorimetrically using the Bioxytech GSH-400 and LPO-586 kits, respectively. The activity of glutathione peroxidase was assessed colorimetrically using the Bioxytech GPx-340 kit. Statistical analysis was performed using ANOVA followed by the t test. RESULTS: There was a 47.8% increase in the MDA in the treated rat testis compared with the control rat after 45 days of exposure to cigarette smoke or air, respectively (p < 0.05). This was associated with a parallel significant decrease in the level of glutathione and glutathione peroxidase activity in the treated rat testis, 38.2% and 29.1%, respectively, after 45 days of cigarette smoke exposure (p < 0.05). No significant difference was noted in the levels of glutathione, glutathione peroxidase, and lipid peroxidation end products after 15 and 30 days of treatment. CONCLUSIONS: Chronic cigarette smoke inhalation is associated with an increase in the level of oxidants and a simultaneous decrease in the level of antioxidants in the rat testis. This abnormality of the oxidant-antioxidant balance may be one of the mechanisms leading to testicular tissue damage and abnormal spermatogenesis in the rat testis following chronic inhalation of cigarette smoke.

Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: a prospective, randomized, multicenter clinical trial.

OBJECTIVES: To examine the efficacy of bladder catheters impregnated with minocycline and rifampin in reducing catheter-associated bacteriuria. METHODS: A prospective, randomized clinical trial was conducted at five academic medical centers. Patients undergoing radical prostatectomy were randomized to receive intraoperatively either regular silicone bladder catheters (control catheters) or silicone bladder catheters impregnated with minocycline and rifampin (antimicrobial-impregnated catheters). Catheters remained in place for a mean of 2 weeks. Urine cultures were obtained at about 3, 7, and 14 days after catheter insertion. Bacteriuria was defined as the growth of organism(s) in urine at a concentration of 10(4) colony-forming units per milliliter or greater. RESULTS: Kaplan-Meier analysis demonstrated that it took significantly longer for patients (n = 56) who received the antimicrobial-impregnated catheters to develop bacteriuria than those (n = 68) who received the control catheters (P = 0.006 by the log-rank test). Patients who received the antimicrobial-impregnated catheters had significantly lower rates of bacteriuria than those in the control group both at day 7 (15.2% versus 39.7%) and at day 14 (58.5% versus 83.5%) after catheter insertion. Patients who received the antimicrobial-impregnated catheters had significantly lower rates of gram-positive bacteriuria than the control group (7.1% versus 38.2%; P <0.001) but similar rates of gram-negative bacteriuria (46.4% versus 47.1%) and candiduria (3.6% versus 2.9%). The antimicrobial-impregnated catheters provided zones of inhibition against Enterococcus faecalis and Escherichia coli, both at baseline and on removal. CONCLUSIONS: Bladder catheters impregnated with minocycline and rifampin significantly reduced the rate of gram-positive catheter-associated bacteriuria up to 2 weeks after catheter insertion.

Lipid peroxidation and antioxidant activities in rat testis after chronic cocaine administration.

OBJECTIVES: Our recent study has shown that cocaine has adverse action on spermatogenesis and fertility in male rats. Adverse effects of cocaine on the testes may be mediated by oxidative damage and subsequent lipid peroxidation. Glutathione is a cellular antioxidant and is found in high concentrations in the rat testes. In this study, the effects of chronic cocaine administration on the activities of glutathione peroxidase, the level of testicular reduced glutathione, and lipid peroxidation were investigated. METHODS: Thirty-day-old male Sprague-Dawley rats were given cocaine hydrochloride (15 mg/kg body weight) subcutaneously daily for 90 days. Control animals received equal volumes of normal saline daily for 90 days. Testes were removed at 15, 30, 60, and 90 days after cocaine injection. Tissues were washed and homogenized in ice-cold metaphosphoric acid solution or Tris-HCI buffer. Reduced glutathione, glutathione peroxidase, and malonaldehyde levels were determined by colorimetric assay. Statistical analysis was performed using analysis of variance. RESULTS: Testicular reduced glutathione and glutathione peroxidase were significantly decreased in the treatment testes 15, 30, 60, and 90 days after chronic cocaine injection compared with controls (P <0.05). The testicular malonaldehyde level was 20.8% (P <0.05), 22.1% (P <0.05), 31.2% (P <0.05), and 24.7% (P <0.05) above the control value on days 15, 30, 60, and 90, respectively. CONCLUSIONS: Our findings demonstrate that chronic administration of cocaine to male rats induces a depletion of reduced glutathione and glutathione peroxidase. Adverse effects of cocaine on the testes are at least in part due to impairment of the function of the antioxidant defense and further enhancement of lipid peroxidation.

Penile implant success in patients with corporal fibrosis using multiple incisions and minimal scar tissue excision.

OBJECTIVES: To establish the efficacy of "minimal scar tissue excision" in the treatment of penile fibrosis. METHODS: Thirty-four patients with extensive penile fibrosis who underwent placement of penile implant from October 1989 to April 1998 were evaluated by a chart review of the patient's follow-up data. Function of the implant was evaluated at follow-up visits. The follow-up ranged from 4 to 84 months (mean 23.7, median 22). All patients had undergone minimal scar tissue excision of the fibrous tissue in the penis. RESULTS: All patients underwent successful introduction of the penile implant, and in no patient was the procedure abandoned because of technical difficulty. Intraoperatively, 1 patient developed a tear in the crus. It was not recognized during the initial operation but was repaired at a subsequent date by Gore-Tex grafting. The Uniflate prosthesis of another patient failed 2 years after the initial surgery and was replaced with the Mentor alpha-1 implant. None of the patients developed infection. All the patients had a functioning implant at the time of last review. CONCLUSIONS: Minimal scar tissue excision is a safe and effective method in the management of extensive penile fibrosis.

Cocaine induced apoptosis in rat testes.

PURPOSE: Exposure of rats to chronic cocaine results in disruption of spermatogenesis including reduction of germ cells. However, the cellular mechanism responsible for the testicular damage in testes is still unknown. We have studied the role of apoptosis in cocaine induced testicular damage. MATERIALS AND METHODS: Thirty-day-old male Sprague-Dawley rats were given cocaine hydrochloride (15 mg./kg. body weight) subcutaneously daily for 90 days. Control animals received equal volumes of normal saline daily for 90 days. Testes were removed at 15, 30, 60, and 90 days of cocaine administration. In situ detection of germ cells with DNA strand breaks in paraffin-embedded testicular section (5 microm.) was achieved by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick end-labeling (TUNEL) method. DNA fragmentation was also determined by gel electrophoresis. RESULTS: Apoptotic cells were found in the spermatocytes and spermatogonia of germinal epithelium. Less than 7% of seminiferous tubule cross sections showed a high level of apoptosis (> or =3 apoptotic cells per tubule) in control animals compared with experimental group where 25% of the tubules showed a high level of apoptosis (p<0.05). The number of apoptotic cells was significantly increased by 15 days, peaked at 30 days and persisted up to 90 days of cocaine exposure when compared with controls (p<0.05). DNA isolated from the cocaine treated testes displayed a clear ladder pattern whereas the DNA from controls did not. CONCLUSIONS: The experimental results presented here suggest that cocaine exposure leads to significant apoptosis in rat testes and the mechanism of cocaine induced testicular injury may be related to the induction of apoptosis.

Effect of surgically induced varicocele on testicular blood flow and Sertoli cell function.

OBJECTIVES: To evaluate the effect of varicocele on testicular blood flow and expression by Sertoli cells of transferrin and androgen-binding protein (ABP), to determine whether varicoceles impair Sertoli cell function. METHODS: Experimental varicocele was established in male Sprague-Dawley rats by partial ligation of the left renal vein. The control group received a sham operation. At 30 minutes after surgery, rats underwent a xenon-133 washout study, and at 30 days after surgery, transferrin, ABP, and testicular blood flow were evaluated. Expression of transferrin and ABP were evaluated using immunohistochemical techniques. Testicular blood flow was measured using xenon-133 clearance techniques. Statistical analyses were done with an independent t test. RESULTS: The testicular blood flow was 16.7 +/- 1.25 mL/100 g/min in varicocele-bearing rats and 21.01 +/- 0.46 mL/100 g/min in sham-operated rats 30 minutes after surgery. Testicular blood flow remained decreased at 30 days in varicocele-bearing rats (15.12 +/- 1.08 mL/100 g/min) and remained stable in the control group (19.45 +/- 0.55 mL/100 g/min). The expression of transferrin and ABP was significantly reduced in varicocele-bearing rats compared with the control group. CONCLUSIONS: Our study suggests that a decrease in testicular blood flow may lead to impaired Sertoli cell function in varicocele-bearing rats.

Effect of cocaine on testicular blood flow in rats: evaluation by percutaneous injection of xenon-133.

PURPOSE: Cocaine abuse has reached epidemic proportions in the United States. Our recent study has shown that cocaine has adverse action on spermatogenesis and fertility in male rats. The indirect action of cocaine occurs by blocking the reuptake of neurotransmitter, which causes local vasoconstriction. In this study we evaluate blood flow to the testes after subcutaneous injection of cocaine to male rats. METHODS: Male Sprague-Dawley rats were divided into two main groups. The treatment group received subcutaneous cocaine (30 mg/kg body weight) and the control animals received normal saline. Xenon-133 wash out experiments were carried out on testes at 5, 10, 15, 20, 30, 45, 60, 90 min and 4.5 hours after injection of cocaine or normal saline. Statistical analysis was done by SPSS V. 7.S for windows. P < 0.05 was considered statistically significant. RESULTS: There was a reduction in testicular blood flow after cocaine administration to male rats. This vasoconstrictor effect was most pronounced at 15 min after injection of cocaine and persisted up to 60 min. At 90 min, the early restitution of blood flow to ischemic tissue occurred. There was a significant increase in testicular blood flow in cocaine-treated groups than in the control group during restitution phases at 90 min. At 4.5 hours, there was no difference in blood flow in both groups. CONCLUSION: This study demonstrates that cocaine, when given subcutaneously at a 30 mg/kg body weight dose, results in prolonged vasoconstriction of the blood vessels to the testes. Adverse effects of cocaine on the testes may be in part due to ischemic and postischemic reperfusion injury to the organ.

Treatment outcome after radical prostatectomy is not adversely affected by a pre-existing penile prosthesis.

OBJECTIVES: To report on the safety of radical retropubic prostatectomy (RRP) in patients with a penile prosthesis presenting with clinically localized prostate cancer. METHODS: From January 1990 to December 1997, 8 consecutive men with a penile prosthesis underwent RRP for clinically localized prostate cancer. Retrospective data regarding patient population, operating time, estimated blood loss, length of hospital stay, and clinical outcome were evaluated. RESULTS: Mean patient age was 65.4 years (range 57 to 70) at the time of RRP, with a mean preoperative serum prostate-specific antigen level of 11.5 ng/mL. Mean duration of RRP surgery was 183.9 minutes, and the mean estimated blood loss was 1281.8 mL. No complication requiring penile prosthesis removal occurred. In 1 case, the reservoir tubing was punctured during closure of the abdominal fascia wall. This was immediately recognized and fixed. All patients had a functioning penile prosthesis after RRP. CONCLUSIONS: RRP can be safely and expeditiously performed in patients with a pre-existing penile prosthesis. The risk of prosthesis malfunction after RRP is very low. Patients with a penile prosthesis and prostate cancer should not be denied the option of undergoing RRP.

Assessment of psychosexual adjustment after insertion of inflatable penile prosthesis.

OBJECTIVES: To evaluate the psychosexual benefit obtained from multicomponent penile implant surgery in patients with erectile dysfunction. METHODS: A psychosexual questionnaire was given to 35 patients undergoing penile prosthesis implantation before surgery and at 3 months, 6 months, and 1 year after surgery. The questionnaire consisted of 13 questions scored on a scale from 1 through 5. Results of the questionnaire were statistically analyzed for differences among the preoperative, 3-month postoperative, 6-month postoperative, and 1-year postoperative period. RESULTS: The general linear model evaluation showed a significant difference for each overall combination of the following pairs: preoperative versus 3 months postoperative (P=0.0005) and 3 months postoperative versus 6 months postoperative (P=0.002). There was no overall difference between psychosexual total score at 6 months after surgery and 1 year after prosthesis implantation (P=0.85). The patients perceived improvement in their erectile ability and libido. Concern about obtaining and maintaining an erection during intercourse was significantly alleviated. There was an increase in the frequency of sexual activity and an improvement in satisfaction with sex life. A decrease in feelings of sadness, depression, anxiety, anger, frustration, and embarrassment related to sexual activity was also noted. CONCLUSIONS: The current study demonstrates significant improvement in the psychosexual well being of multicomponent penile implant recipients, with attainment of a high level of patient satisfaction up to 1 year after surgery.

Antibacterial activity of antibiotic coated silicone grafts.

PURPOSE: Postoperative infection remains one of the most serious complications of implantation of penile prostheses. Attempts to reduce the rate of infection by spraying the prosthesis with an antibiotic solution prior to implantation, along with perioperative antibiotics, have failed to eradicate infection. No published studies have evaluated the effect of antibiotic coating of penile prostheses. In this study, we evaluate the antibacterial effect of antibiotic-coated silicone strips as a surrogate for the penile prosthesis. MATERIALS AND METHODS: Strips coated with several different antibiotics were dipped in bacterial solutions containing Staphylococcus epidermidis or S. aureus and implanted subcutaneously in adult Sprague-Dawley rats. After a week, the strips were removed, and the number of bacteria on the strips and in the surrounding tissue were determined. The in vitro antibiotic activity of the antibiotic-coated strips against the same organisms was also determined. RESULTS: In the group of rats that received silicone strips contaminated in vitro with S. epidermidis, six of nine control rats yielded strips and tissues containing heavy bacterial growth. None of six strips coated with rifampin/minocycline yielded bacterial growth, nor did any of the seven strips coated with vancomycin. One of seven rats that received amikacin-coated strips had infection of the strip. The tissue results were similar to the strip results. In the group using S. aureus as the contaminating bacterium, the strips and tissues from eight of nine control rats yielded bacteria. None of the six rifampin/minocycline-coated strips yielded bacteria, while two of seven vancomycin-treated strips and two of six amikacin-coated strips were infected with S. aureus. The difference in bacterial growth between controls and antibiotic-coated strips reached a level of statistical significance for the rifampin/minocycline and vancomycin groups and was highly significant for the rifampin/minocycline groups. CONCLUSION: The experimental results presented here suggest that coating silicone graft material with antibiotics, particularly rifampin/minocycline, can reduce the incidence of graft colonization in contaminated wounds in rats, even in the absence of systemic antibiotics. These graft materials may prove useful in preventing the infection of penile prostheses.

Long-term mechanical reliability of multicomponent inflatable penile prosthesis: comparison of device survival.

OBJECTIVES: To determine the mechanical reliability of multicomponent inflatable penile prosthesis, comparing five different types of devices, as well as the two-piece versus three-piece as a group. METHODS: We followed 83 patients with two-piece and 283 patients with three-piece inflatable penile prostheses for a mean time of 66 months. At a cutoff of 63 months, mechanical complication rates were reviewed and statistically analyzed. RESULTS: Thirty-one device-related complications occurred, and all were secondary to fluid leakage. The Mentor Alpha-1 prosthesis was significantly better than the Mentor Mark-II in terms of mechanical reliability (P = 0.01). A trend was noted toward the AMS 700 Ultrex inflatable penile prosthesis having fewer mechanical complications than the Mentor Mark-II (P = 0.06). In addition, a trend toward all three-piece prostheses being more mechanically reliable than the two-piece was noted (P = 0.08). The Mentor Alpha-1 device had a higher cumulative proportional survival (0.957) than all other devices (0.842 for AMS 700 Ultrex, 0.839 for AMS 700 CX, 0.783 for Mentor GFS, and 0.750 for Mentor Mark-II). CONCLUSIONS: As a group, a trend was noted toward the three-piece prosthesis having better mechanical reliability than the two-piece prosthesis. Comparisons between the individual types of prostheses showed thatthe Mentor Alpha-1 device was significantly more mechanically reliable than the Mentor Mark-II device, and a trend was noted toward the AMS 700 Ultrex device having fewer mechanical complications than the Mentor Mark-II. The Mentor Alpha-1 prosthesis had the highest cumulative proportional survival.