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No-Touch Technique Description for Medical Professionals

The No-Touch Technique adheres to many of the practices associated with standard surgical sterility. Patients are placed on an oral fluoroquinolone for three days prior to the procedure and instructed to scrub the lower abdomen and genitals twice daily with chlorhexidine soap. Vancomycin and gentamicin are administered intravenously two hours prior to the start of the procedure. The lower abdomen and genitals are shaved, followed by a 5 minutes chlorhexidine/alcohol (Chloraprep). Surgical drapes are placed, followed by a Vi drape over the genitalia; The penis and scrotum are delivered through a small fenestration of the Vi drape and a capped Foley catheter is inserted int the bladder. An incision is made in the penoscrotal raffe and the dissection is carried down through the through the subcutaneous tissues to the level of Bucks fascia. A Scott retractor is employed with blunt hooks to maintain exposure. 


Penile implant surgery - Dr. Francois Eid


At this point, the No-Touch principles are employed. The procedure is halted and all of the surgical instruments used thus far, including the Bovie, are removed from the surgical field and considered contaminated. All surgical gloves are changed. The 3M #1012 drape is used to losely drape the operative field. A small fenestration is made in the drape and blunt hooks are used to retract and secure the cut edges of the drape to the edges of the skin incision.

penile implant surgery penile implant surgery penile implant surgery penile implant surgery

Implantation of the device proceeds with the usual steps associated with a multi-component prosthesis, including the incision and dilation of the corpora; sizing and placement of the penile components; and placement of the pump in the scrotum and the reservoir in the retropubic space, all through the small fenestration in the #1012 drape. Injectable saline is used for irrigation in all cases. Once the corporotomies are closed and all of the tubing has been covered with a layer of Buck’s fascia, the drape is removed and the subcutaneous tissues and skin are closed.


Materials and Methods

  • Penile implant surgery - preparation

    N=1,927 IPP on virgin and revision patients between 2002 and 2010

  • Both manufacture's 3-piece IPP were used – approximately 2:1 Coloplast Titan: AMS

  • Patients were similar in age and comorbidilies

  • In 2002, non-coated implants were used and the remaining years infection retardant coated IPP were implanted

  • The last four years the No-Touch Technique was performed

  • Infection rates in the three groups were examined and subjected to statistical analysis

Results


Implants Infections Infection %
Non-coated implants
(2002)
132 7 5.3%
Coated implants
(2003-2006)
720 13 1.8%
Coated implants plus No-Touch Technique
(2006-2010)
1275 8 0.7

Conclusion

Infection retardant coatings lower risk of infection from 5.3% to 1.8%. The No-Touch enhancement to the surgical procedure results in additional improvement to 0.7%.

Initial results of the No-Touch Technique

The records of 537 consecutive patients that underwent insertion of a multi-component penile prosthesis by a single surgeon using the No-Touch Technique over a two-year period were reviewed. Patients answered a pre-operative questionnaire regarding their medical and surgical history. Penile size and girth were the determining factors in deciding which prosthesis model (i.e., antibiotic-coated or not) were chosen for each patient.

Total Patients 537 Percent
Virgin implant 491 91.4%
Replacement 46 8.6%
Diabetic 230 42.8%
Antibiotic impregnated 208 38.3%
Non-antibiotic impregnated 329 61.7%
Infections 5 0.93%


References:

  1. Carson, C.C., Efficacy of antibiotic impregnation of inflatable penile prosthesis in decreasing infection in original implants. J Urol 171: 1611, 2003.
  2. Henry, G. D. et al. Revision washout decreases penile prosthesis infection in revision surgery: A multicenter study. J Urol 173: 89, 2005.
  3. Lotan, Y., Roehrborn, C.G., McConnell, J.D., Hendin, B.N., Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urol 62: 918, 2003.
  4. Jarow, J.P., Risk factors for penile prosthetic infection. J Urol 156 (2): 402, 1996.
  5. Wilson, S.K., Zumbe, J., Henry, G.D., Salem, E.A., Delk, J.R., and Cleves, M.A. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urol 70 (2): 337, 2007.
  6. Henry, G.D., Carson, C.C., Wilson, S.K., Wiygul, J., Tornehl, C., Cleves, M.A., Simmons, C.J., and Donatucci, C.F. Revision washout decreases implant capsule tissue culture positivity: A multicenter study. J Urol 179: 186, 2008.