SAN DIEGO — Contrary to what might be expected, adding an antibiotic coating to an artificial urinary sphincter (AUS) does not decrease device-related infection rates, researchers announced at the 108th American Urological Association (AUA) Annual Meeting.

In their study, 213 men with urinary incontinence who received an AUS without antibiotic coating had the same infection rate as 213 men who were implanted with the antibiotic-coated AUS (InhibiZoneR).

Daniel S. Elliott, MD, associate professor of urology at the Mayo Clinic College of Medicine in Rochester, Minnesota, observed:

“The antibiotic coating was introduced to emit antibiotics for up to 12 days after implantation in order to reduce bacterial colonization of the prosthetic device.

As it turns out, the antibiotic coating adds about $1,300 to the cost of the device without providing any clinical benefit.”

The AUS is the treatment standard for male stress urinary incontinence. Several design modifications have been introduced over the 40 years since the device was introduced, leading to better outcomes and fewer complications.

While antibiotic treatment of other indwelling or implantable devices, such as urinary catheters, central lines, and inflatable penile prosthesis has been demonstrated to thwart infection, there have been no studies comparing infection rates with non-antibiotic-coated versus antibiotic-coated AUS devices, Dr. Elliott said.

Results of the Mayo Clinic study showed a 3.3% overall infection rate in both groups.

Likewise, infection rates were similar in the more complex subgroup of revision patients (5% for the antibiotic-coated device and 6% for the non-antibiotic-coated device).

Dr. Elliott said that, at least for now, the most cost-effective method of avoiding AUS infections is minimal wound handling and increased wound irrigation.

Given the lack of data supporting antibiotic coating for the AUS, his institution has reverted to the use of non-antibiotic-coated AUS devices for most patients.

Finally, he urged his urology colleagues to analyze their infection data to determine whether the use of antibiotic-coated devices translates into fewer infections.

Written by Jill Stein
Jill Stein is a Paris-based freelance medical writer.