Men who develop infections related to penile implant surgery may benefit from conservative antibiotic therapy, according to new research published in the Journal of Sexual Medicine.
The incidence rate of such infections ranges from 1% to 4%, but up to 20% of high-risk patients may develop infections. Typically, treatment calls for the removal of the implant, a regimen of intravenous and oral antibiotics, and re-implantation at a later date. However, the development of scar tissue in the area can cause penile shortening and difficulty replacing the implant.
The conservative approach would be less invasive and less expensive, the researchers said.
The study took place at three medical centers in Saudi Arabia. Four hundred eleven men received a penile implant between June 2011 and July 2014. Of these, 37 patients developed infections, which were characterized by pain, swelling, tenderness, reddening of the skin, opening of the wound (dehiscence), abscess formation, erosion, or discharge. These men underwent conservative antibiotic therapy with weekly checkups. Medications were chosen based on the men’s individual needs.
All of the affected men had diabetes. Their average age was 58 years. Thirty-three of them had malleable implants—flexible rods that a man can move to an erect position as desired. Four men had inflatable devices, which include a pump that, when activated, sends fluid from a reservoir to cylinders in the penis, thus creating an erection.
The authors reported an overall success rate of 84%. Four of the patients did not respond well to therapy and had to have their implants removed. Two other men did heal completely, but because of persistent pain, also had to have their implants removed. The remaining 31 patients completely healed in an average of seven weeks. These men were able to resume sexual intercourse.
Four participants had been infected by pseudomonas; conservative therapy was unsuccessful in all of these men.
Conservative therapy could be less expensive than replacing an implant, the authors pointed out. They noted that in their facilities, a malleable implant procedure cost about $6,000. Conservative therapy would only cost about 15% of this figure, they said. (They added that inflatable implants cost approximately $13,500.)
The medical benefits were also notable, they explained. The men who did well with conservative therapy avoided further surgery, anesthesia complications, and the possibility of poor results with a second implant. Experts caution that although this study presents some intriguing preliminary data, it requires external validation and further study before being routinely adopted in all cases. This is particularly relevant since it is unclear if the devices themselves were infected, or if these represented more superficial wound infections, which would be more amenable to conservative therapies. Additionally, as malleable devices are generally more resilient to infections compared to inflatable prosthetics, it is unclear how the findings from the current study would extrapolate to other populations, wherein inflatable devices are more commonly utilized.
All cases of penile implant infection need to be evaluated individually by the treating physician, experts say.
The Journal of Sexual Medicine
Habous, Mohamad, MS, FEBU, FECSM, et al.
“Conservative Therapy is an Effective Option in Patients With Localized Infection After Penile Implant Surgery”
(Full-text. Published online: May 7, 2016)