The artificial urinary sphincter (AUS) is a standard treatment for moderate-to-severe neurogenic and non-neurogenic stress urinary incontinence (SUI) in men.(1) . Prosthetic infection and/or erosion is a significant complication, which requires device explantation, eventually followed by delayed reimplantation (with lower success rates than primary implantation). Early infection and/or erosion, occurring within three months after AUS surgery, may result from perioperative infection or urethral trauma. The reported rate these complications is 8,5% (range 3,3%-27,8%), typically occurring within two years after implantation. (2) Currently, there is limited data on early explantation rates and microorganisms involved in  AUS infections. Staphylococcus Aureus and Staphylococcus Epidermidis are commonly identified pathogens in cases of clinical infection.(3) Clinical guidelines advice the use of perioperative antibiotics. We aimed to identify which microorganisms were associated with early infection-related explants and to optimize our perioperative antimicrobial protocol.

We retrospectively analyzed 255 consecutive AUS surgeries (implant/revision) performed at our hospital between Octobre 2016 and Octobre 2023, focusing on microorganisms associated with early infection-related explants.

Of the 255 AUS surgeries, 148 cases (58%) were primary implants and 107 cases (42%) were revisions or reimplantations. There were eight infections (3,1%) within three months after AUS surgery, with four cases (1,6%) presenting with concurrent urethral erosion. A list of the cultured microorganisms is presented in table 1.

Early infection occurred in 3,1% of patients that underwent an AUS implant in our institution. A diverse range of bacteria, mainly gram-negative organisms was identified. Based on the antibiogram profiles of the isolated microorganisms, our current perioperative antibiotic protocol (Cefazoline (three times two grams) for 24 hours with or without addition of a single dose of Amikacin (15 mg/kg)) was reviewed in collaboration with the microbiology department. It was concluded that there was no need to change the current protocol, except in patients with a history of extended-spectrum beta-lactamase (ESBL)-producing organisms irrespective of the pre-operative urine culture.

Early AUS infection is an underreported parameter.. We observed an early infection rate of 3.1%, occurring in 8 out of 255 AUS procedures. These findings provide valuable insight for patient counseling regarding expected postoperative care. Contrary to previous reports, we did not observe a predominance of gram-positive organisms, which are often attributed to skin-derived prosthetic infections (3). This suggests that our perioperative skin preparation protocol—including a five-minute povidone-iodine skin scrub followed by skin disinfection with 2% chlorhexidine—may be effective in preventing gram-positive infections. Instead, uropathogens, primarily Escherichia coli, caused most infections (37.5%), with concurrent erosion observed in 50% of cases. These findings highlight the need for targeted antibiotic prophylaxis based on institutional microbial profiles.  In our cohort, prophylaxis with cefazolin alone (53.3%) or in combination with amikacin (35.3%) resulted in a 3.1%. infection rate These findings underscore the need for individualized antibiotic protocols based on institutional microbial patterns.

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