Current approach to the treatment of penile implant infections

Abstract

Modern penile implants, introduced to the market almost four decades ago, have provided a predictable and reliable treatment of erectile dysfunction (ED) despite the development of less-invasive therapies. Infection associated with the placement of these devices does occur, and with prophylactic measures and protocols the incidence has decreased fortunately. In the presence of an infection the implant and all foreign material should be removed. A salvage procedure, during which the wound is thoroughly washed with antiseptic solutions after device removal and placement of a new implant during the same procedure, has a high success rate and is becoming a popular approach. The alternative, device removal with return at a later date for placing a new implant, entails a more difficult corporal dilation, and the resulting erection is noticeably shorter. Patient and partner satisfaction with a penile implant is the highest among all of the treatments for ED.

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

“…In the absence of clear evidence of PP infection (eg, purulent drainage, significant and increasing edema), a trial of oral antimicrobials such as bactrim or ciprofloxacin can be attempted. 6 This trial may also be diagnostic, because the symptoms persistently improve in cases of superficial skin infection, whereas the recurrence of symptoms after stopping the antibiotics is consistent with an actual PP infection requiring explantation.…”

“…However, in the past decade, the understanding of the mechanisms and causes of infection has increased, which has led to markedly decreased infection rates. 6 At present, the most commonly implanted device for ED treatment is the inflatable PP, a 3-piece device consisting of 2 corporal cylinders, a pump, and a separate reservoir. 4 An alternative for patients is the semirigid (malleable) prosthesis or a 2-piece PP.…”

“…Hallmarks of the physical examination are fever with or without chills, erythema of the scrotum and/or penile shaft, fluctuance around the pump or cylinders, purulent drainage from the incision site, and a pump that may be fixed to the scrotal wall. 6 Imaging such as a computed tomographic (CT) scan or preferably an MRI 7 may aid in the diagnosis and should be considered for evaluating the location and also involvement of the intra-abdominal reservoir. One advantage of the MRI is that it allows assessment of penile anatomy in 3 orthogonal planes and can be used to differentiate PP-associated infections from some of the other conditions associated with similar symptoms.…”

Association between Coronary Artery Disease and Erectile Dysfunction in Patients of a University Hospital

“…Several physical and psychological components are involved in erectile function, including hormonal, neurological, vascular and cavernous body diseases 2,3 . Studies have demonstrated a high prevalence of ED in men with cardiovascular diseases, since both diseases have several risk factors in common 4,5 .…”

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

“…The presence of diabetes, urinary tract infections, blood coagulation disorders, immune depression, duration of hospitalisation, inappropriate surgical technique and prolonged surgery time should all be assessed (19).A psychological assessment is also important, to understand if the patient is aware not only of the benefits of a penile implant but also of its impact on his personal and relational life (use of loose clothing, practice of nudism, swimming, sports and gym activities, cycling or competitive motorcycling, medical follow-up and examinations).Prosthetic infections are a complex problem. If not immediately resolved on initial antibiotic treatment, removal of the infected implant is considered mandatory.…”