Male Fertility & Men's Health

Penile Prosthesis Biofilms

The Men's Health Center, in collaboration with the Lerner Research Institute, continues to investigate mechanisms behind urologic implant infections. One recent study showed that penile implants may harbor more — and more complex — surface-level microbes than previously understood. The research team set out to better understand the composition of the penile prosthesis microbiome present in the biofilms of devices undergoing explant and determine the propensity of the isolated microbes to reconstitute biofilm formation on various materials by swabbing biofilms from patients who were scheduled for device removal or revision. Biofilm samples and controls were subjected to a series of assays including next-generation sequencing, metabolomics and culture-based assessments to determine the bacterial composition, in addition to analysis of clinical associations with microbial composition. Researchers then isolated and replicated the bacteria on various surfaces—including silicone, polytetrafluoroethylene, polyurethane, polycarbonate and titanium — in an in vitro environment designed to simulate interaction with human tissue.

The initial findings (which were presented at the 2023 American Urological Association Meeting in Chicago and recognized with an award for Best Poster) showed that nearly all of the devices in the study harbored robust microbiota, even in the absence of infection. Below is a summary of the findings:

  • 93% of all the devices harbored a biofilm despite most coming from non-infected devices.
  • Seven genera including Faecalibaculum (log2 fold change + 4.10, P < 0.001), Jeotgalicoccus (+3.22, P < 0.001) and Nosocomiicoccus (+2.94, P < 0.001) were more abundant in infected than uninfected device biofilms.
  • Eight microbial genera were more abundant in the presence of pain.
  • Patients who smoke and those with diabetes mellitus or cardiac disease had lower microbial counts (P < 0.001).

These findings could lead to new information about the transition from non-infected to infected states and also inform the next generation of medical device coatings and materials. It also opened for exploration the notion that clinical infections should be prevented or treated through approaches that target specific infectious processes, rather than the broad brushstroke antibiotic measures that are common today.