A penile implant, also known as a penile prosthesis, is a medical device surgically placed within the penis to manage erectile dysfunction. These devices provide rigidity for sexual intercourse when other treatments are ineffective or unsuitable. While the surgery has high satisfaction rates, infection is a serious, though uncommon, complication. Understanding the nature of these infections, their symptoms, and available treatments is important for anyone considering or living with a penile implant.
The Nature of Penile Implant Infections
The presence of a penile implant, a foreign body, makes the local environment more susceptible to infection. Bacteria can adhere to the device’s surface and form a protective layer known as a biofilm. This matrix shields microorganisms from the body’s immune cells and antibiotics, making the infection difficult to eradicate with medication alone and potentially leading to chronic inflammation.
Infections from initial implant surgeries are often caused by common skin bacteria, such as Staphylococcus epidermidis, which may cause delayed, low-grade infections. Conversely, infections in revision surgeries or those that appear more acutely are caused by more virulent organisms. These can include Staphylococcus aureus, Gram-negative bacteria like E. coli and Pseudomonas aeruginosa, or fungi such as Candida, which cause more severe infections.
Several factors increase a patient’s risk of an implant infection. A history of previous implant surgery is a risk factor, with infection rates increasing from 1-3% for a first-time implant to 18% for a revision. Poorly controlled diabetes is another concern, as high blood sugar impairs immune function and wound healing. Other conditions like a spinal cord injury or a compromised immune system also predispose an individual to infection.
Recognizing Symptoms of Infection
The signs of a penile implant infection can range from subtle to severe and may appear shortly after surgery or develop months or even years later. Infections are classified as immediate if they occur within the first eight weeks or indolent if they manifest after that period. Immediate infections are more obvious, presenting with clear signs of a surgical site infection.
Common localized symptoms include persistent pain beyond the expected recovery period, tenderness over the device components, and swelling of the scrotum or penis. Redness of the skin and a feeling of warmth at the surgical site are also frequent indicators. A definitive sign of infection is the discharge of pus or cloudy fluid from the incision line.
In addition to localized signs, an infection can cause systemic symptoms, signaling a more widespread problem. These can include a fever, chills, and a general feeling of being unwell. A progressive hardening or fixation of the pump to the scrotal skin is a sign of a developing infection.
Diagnostic Process for Implant Infections
Diagnosing a penile implant infection begins with a medical history and a physical examination. A clinician will assess the patient’s reported symptoms, such as pain or drainage, and inspect the genital area for signs of inflammation, fluid collection, or device erosion. The position and feel of the implant components are also checked for abnormalities.
To support clinical findings, laboratory tests are often ordered. Blood tests that measure white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) can help detect inflammation. While these markers are not specific to a penile implant infection, elevated levels can strengthen the suspicion of one.
Imaging studies may be used to get a better view of the implant and surrounding tissues. An ultrasound can help identify fluid collections or abscesses around the device. A magnetic resonance imaging (MRI) scan is more sensitive than a computed tomography (CT) scan for evaluating soft tissues and planning a surgical intervention.
The most definitive diagnostic step is to obtain a fluid or tissue sample from around the implant for culture. This can be done by aspirating fluid with a needle or swabbing any discharge. This process allows the specific bacteria or fungus to be identified and tested for antibiotic sensitivity.
Treatment Pathways for Infected Implants
When a penile implant infection is confirmed, treatment almost always involves surgery, as antibiotics alone are unable to clear the biofilm. The standard approach is complete device removal, also known as explantation. This procedure involves surgically removing all implant components and thoroughly cleaning out the infected tissue from the surgical space.
Following explantation, one strategy is delayed reimplantation. After the infected device is removed, the patient undergoes a course of systemic antibiotics for several weeks or months to ensure the infection is resolved. A new prosthesis can be surgically placed later, but this surgery can be more difficult due to scar tissue, which may result in penile shortening.
A salvage procedure may be an option for certain patients, particularly those with early-stage infections. During a salvage operation, the infected implant is removed, the surgical cavity is irrigated with antiseptic solutions, and a new implant is placed during the same surgery. This technique has a success rate of over 80% and helps preserve penile length. The choice of treatment depends on the severity of the infection, the type of bacteria involved, and the patient’s overall health.
Targeted antibiotic therapy is a part of the treatment plan for any surgical approach. The choice of antibiotics is guided by the results of the culture and sensitivity tests. This ensures the specific microorganism causing the infection is effectively targeted.
Infection Prevention Before and After Surgery
Before the operation, patient optimization is a primary focus. This includes ensuring chronic conditions like diabetes are well-managed by keeping blood glucose levels under control. Patients may be advised to stop smoking before surgery to improve wound healing and to shower with an antiseptic solution like chlorhexidine to reduce skin bacteria.
Intraoperative strategies focus on maintaining a sterile environment. Surgeons employ a strict sterile technique, minimize the duration of the surgery, and may use a “no-touch” technique to prevent the implant from contacting skin. The surgical site is irrigated with antibiotic solutions, and prophylactic intravenous antibiotics are administered before surgery. The use of antibiotic-coated or impregnated implants also significantly reduces infection rates.
After surgery, careful postoperative care is important. This includes proper management of the surgical wound, adhering to the prescribed course of antibiotics, and attending all follow-up appointments. Using a compressive dressing, sometimes called a “mummy wrap,” can help reduce the formation of a hematoma, which is a collection of blood that can increase infection risk.