Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

Abstract

Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial.

Treatment of Penile Prosthesis Implant’s Infection

“…Hematoma is another complication associated with an increased risk of infection. It usually presents in the early postoperative period, with an incidence ranging from 0.2 to 3.6% [12]. Wrapping of the genitalia for a compressive dressing and closed-suction drainage is associated with a statistically significant reduction in the rate of hematoma formation to 0.9% [13-15].…”

HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction

“…Recently, PPI infection rates have significantly declined as a result of anti‐microbial coatings being incorporated onto implant components (Mandava et al., 2012), new skin preparation solution such as Chlorhexidine (Darouiche et al., 2010) and ‘no touch’ surgical technique (Eid et al., 2012). The prevalence of PPI infection varies from approximately 1%–3% (O'Rourke et al., 2017). Current infection rates in Hamad Medical Corporation is 0.83%, a significantly low figure despite coated implant usage not being universally employed.…”

Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine

“…Specialized tools (such as cavernotomes) and advanced surgical adjuvant techniques (such as penile modeling or graft reconstruction) can be utilized in complex surgery, and in cases of significant penile fibrosis, a narrow cylinder–sized implant (or malleable implant) can be used 1 , 46 , 55–57 . There are currently no universal guidelines on postoperative care, and the use and choice of analgesia, antibiotics, and surgical dressing can vary depending on the surgeon’s preference and local institution practice 1 , 58 . The timing of initial device cycling is largely based on the patient’s postoperative comfort level and the surgeon’s own practice 1 .…”