Number of cases: 2953
Infection rate as of 5/2/2013: 1%
|Year||Implant #||Infection #||%|
* No touch technique and saline irrigation only
Prior to 2006, Dr. Eid expertly used state-of-the-art infection prevention techniques, achieving low rates of infection comparable to other prominent penile prosthesis surgeons today.
In 2006, Dr. Eid further reduced his infection rate to well below most penile implant surgeons with his innovative No Touch Technique.
In 2008, Dr. Eid's infection rate dropped to almost 0% (fewer than 1 in 225 surgeries).
Unlike many infections, which require treatment, healing time, etc., an infected inflatable penile prosthesis must be completely removed and replaced. Penile shortening, fibrosis and loss of sensation commonly occur after an infection. Subsequent attempts at re-implantation are extremely difficult, with an increased risk of urethral and penile perforation that often requires additional surgery in the future. For this reason, post-operative infection of a penile prosthesis implant remains one of the most dreaded potential complications of this procedure.
Doctors that perform fewer than 3 penile implants per year account for 70% of all implants currently inserted in patients in the United States. Dr. Eid attributes his ability to conceptualize, develop, and implement the No-Touch Technique to his extensive experience performing penile implantations, over 300 per year. Despite stringent precautions, many urologist infection rates are 5%, and at some institutions post-operative infection rates are as high as 50%. Because the total number of implants performed per year at these institutions is very low, this high infection rate is often not reported and remains undetected. This in turn perpetuates this behavior. Dr. Eid’s No-Touch success rate speaks for itself, with infection rates near zero.
Although accepted in other surgical fields such as Orthopedics where prosthetic devices are routinely used, this innovative concept of completely isolating the skin from the prosthesis device during penile prosthesis implantation has not gained wide acceptance in urology despite Dr. Eid’s proven clinical research and surgical experiences. The belief among many urologists is that regardless of how well the patient’s skin is prepared, or whether the site of the incision is in the scrotal or lower abdominal area, infections occur at a constant rate. This attitude results in a complacent behavior in the operating room and the acceptance or tolerance of a significant but low infection rate, instead of attempting to eliminate infections completely. Also, using an additional piece of equipment such as the No-Touch Drape represents an additional expense as well as an additional step when performing the procedure. Furthermore, when an infection occurs, doctors often blame the patient, the type of procedure or the patient’s underlying medical condition such as diabetes when a post-operative infection occurs.
Dr. Eid came to believe that the best way to eliminate infection is through prevention of exposure to bacteria and normal skin flora. Because skin organisms (e.g. staphylococcus epidermis, staphylococcus aureus, candida albicans) cause most infections, Dr. Eid reasoned that eliminating direct AND indirect contact (for example, through surgical equipment or gloves) between the prosthesis and the skin would most effectively reduce infection rates. In addition, pre and peri-operative antibiotics and antibiotic coating of the device, which is a routinely used strategy to kill skin bacteria is ineffective against fungi such as candida albicans which account for 10% of post-operative infections. Furthermore, during the surgery, adjustments, removal and repositioning of the cylinders, pump and reservoir are often necessary. When performed without the No-Touch Technique, this results in additional direct contact of the device with skin, thus increasing exposure to skin bacteria.
Salvage procedures, where an infected implant is removed and a new device immediately inserted, have been successful in the past even though the new implant is inserted in an infected tissue bed. Dr. Eid believes that “it is the decrease of total bacterial count and exposure to skin, (achieved thru high doses of IV antibiotics and vigorous irrigation performed during the salvage procedure) rather than the complete elimination of bacteria from the surgical area, that accounts for the success of penile prosthesis implantation in this situation.”
“It is crucial to understand this reality,” he explains, “because it gives the implanting physician the tools to further reduce and eliminate infections when performing a virgin implant.” After having developed his No-Touch Technique for use with his own patients, Dr. Eid’s goal now is to make this technique available for all urologists to prevent infection in inflatable penile prosthesis implantation patients throughout the world.