Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications

Abstract

Inflatable Penile Prostheses (IPP) implantation is a surgical treatment for patients desiring definitive treatment for erectile dysfunction. While this procedure has proven to be effective, it also carries its own set of unique risks that need to be carefully considered. The article reviews the current understanding of complications associated with penile prosthetic surgery and provides strategies to mitigate these adverse events. This article covers various aspects of IPP implantation, including the risks of infection, bleeding, injury to nearby structures, glans ischemia, and device malfunction. It also discusses the importance of careful preoperative screening to identify risk factors and the implementation of infection reduction strategies such as antimicrobial prophylaxis, skin prep, and operative techniques. In addition, it emphasizes the need for postoperative vigilance and prompt management of any complications that may arise. Overall, the article provides a comprehensive overview of the risks and strategies for mitigating complications associated with IPP implantation. Our recommendations are given based on the current consensus in the field and highlight the importance of careful planning, attention to detail, and effective communication between healthcare providers and patients. Despite the potential risks, this review underscores the fact that complications following penile prosthesis implantation are relatively rare.

Changing Trends in the Penile Prothesis Implantation of male with refractory Erectile Dysfunction in China

“…PPI stands out as one of the most intricate procedures in the eld of male andrology. 10 The observed increase in the number of surgeons performing this procedure across China from 33 in 2019 to 74 in 2023 indicates a positive trend in the development of expertise in this highly specialized area. However, a critical analysis reveals that, despite this growth, the pro ciency in PPI remains concentrated within a remarkably limited cohort of surgeons.…”

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

“…As PP utilization has increased, prosthesis technology and complication management strategies have also evolved ( 1 , 2 ). Despite improvements in surgical technique and hardware, prosthesis infection, a devastating complication of PP surgery, is estimated to occur in 1–4% of virgin cases ( 6 , 7 ). Historically, standard of care for PP infection included broad spectrum antibiotics, complete device removal, and delayed replacement if desired.…”

“…This technique reduced corporal fibrosis and loss of penile length associated with PP explantation by immediately placing a new prosthesis after the removal of infected hardware and extensive wash-out ( 10 ). Reinfection rates following immediate salvage (IS) are low at <10% ( 7 , 11 ). Further development of salvage techniques, the malleable implant salvage technique (MIST) variation in particular [a variation of Mulcahy’s salvage technique that utilizes a malleable PP (MPP)], have simplified the salvage procedure, reduced reinfection rates, and challenged dogma regarding contraindications to IS ( 11 , 12 ).…”

Successful re‐implantation of eroded penile prostheses: Report of two cases and review of the literature

“…In case of extension of the perforation to the overlying skin, erosion ensues 2,4 . The most common risk factors are attenuated penile sensitivity (e.g., diabetics and paraplegics), vascular diseases, and repeated urethral catheterization 5,6 . Malleable PPs (MPPs), also known as semi‐rigid PPs, are especially prone to erosion because of their constant erect state 7 .…”