AI Article Synopsis
- The study examined acute kidney injury (AKI) rates in patients undergoing urologic prosthetic surgeries after the introduction of weight-based gentamicin dosing, recommended by the American Urological Association in 2008.
- The research involved a retrospective analysis of 124 patients from 2000 to 2017, comparing outcomes between those given weight-based gentamicin (5 mg/kg or adjusted for renal function) and those receiving standard doses (80 mg).
- Findings revealed no significant difference in AKI rates between the two groups, despite the weight-based group being older and receiving higher doses of gentamicin.
Article Abstract
Background: Despite the known nephrotoxicity of gentamicin, in 2008 the American Urological Association recommended a weight-based gentamicin dose of 5 mg/kg for antimicrobial prophylaxis during urologic prosthetic surgery.
Aim: To identify and characterize rates of acute kidney injury (AKI) in urologic prosthetic surgery, both before and after the implementation of weight-based gentamicin dosing.
Methods: We performed a single-institution retrospective study of patients receiving perioperative gentamicin during implant, revision, salvage, or explant of inflatable penile prostheses, malleable penile prostheses, or artificial urinary sphincters between the years 2000 and 2017. Patients were stratified into 2 groups, based on administration of either weight-based gentamicin (5 mg/kg or 2-3 mg/kg in cases of poor renal function) or standard-dose gentamicin (80 mg). Patient characteristics and perioperative outcomes were identified. Patients with available preoperative and postoperative (≤7 days) serum creatinine values were included. AKI was defined by Kidney Disease: Improving Global Outcomes criteria. Comparative analyses were performed between groups.
Main Outcome Measure: Our primary outcome was incidence of AKI, with secondary outcomes including device infection rate and length of stay.
Results: Of the 415 urologic prosthetic surgeries performed during the study period, 124 met inclusion criteria with paired preoperative and postoperative serum creatinine values. 57 received weight-based gentamicin (median dose 5.06 mg/kg, interquartile range [IQR] 3.96-5.94) and 67 received standard-dose gentamicin (median dose 1.07 mg/kg, IQR 1.04-1.06), P < .001. There were no significant differences in preoperative renal function or comorbidities between groups; however, the weight-based group was older (median age 64.0 years, IQR 60.0-68.5) compared with the standard-dose group (median age 61.0 years, IQR 55.0-66.0), P = .01, and comprised fewer explant cases (1.8%, 1 of 57) than the standard-dose group (13.4%, 9 of 67), P = .02. The AKI rate was significantly higher in the weight-based group (15.8%, 9 of 57) compared with the standard-dose group (3.0%, 2 o67), P = .02. Device infection rate was similar between groups (5.3%, 3/56 vs 5.2%, 3 of 58), P = 1.00.
Clinical Implications: Our data suggest weight-based perioperative gentamicin prophylaxis may be associated with an increased AKI risk, without noticeably improving infection rates.
Strength & Limitations: Strengths of our study include the Veterans Affairs population analyzed, as well as rigorous inclusion criteria that allowed for a sensitive assessment of postoperative renal function. Limitations include the retrospective design and small sample size.
Conclusion: Weight-based gentamicin dosing may warrant closer perioperative monitoring of renal function, and merits larger investigations to further elucidate risks and benefits. Moore RH, Anele UA, Krzastek SC. Potential Association of Weight-Based Gentamicin with Increased Acute Kidney Injury in Urologic Prosthetic Surgery. J Sex Med 2019;16:137-144.
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| http://dx.doi.org/10.1016/j.jsxm.2018.10.016 | DOI Listing |
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Article Synopsis
- The American Urological Association recommended a single high-dose gentamicin prophylaxis (5 mg/kg) in 2008 for urologic procedures due to its theoretical safety and effectiveness.
- However, there's a lack of evidence-based studies confirming the safety of this practice specifically in penile prosthetic surgery.
- The text presents three cases where patients experienced acute kidney injury after receiving weight-based gentamicin prophylaxis during inflatable penile prosthesis implantation, highlighting potential safety concerns.
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