No surgery needed: Antibiotic treatment alone may be enough to treat penile implant infections

This study examined whether conservative therapy (antibiotics only) is effective in treating infections of penile implants. Authors concluded that conservative therapy is a safe and effective treatment option for penile implant infections.

Men with severe erectile dysfunction may undergo the placement of a penile implant. This involves the surgical placement of a prosthetic device into the penis to enable penetrative sexual activity. Advances in penile implants have led to devices being more effective and have reduced complication rates. One of the most serious complications is when a bacterial infection develops around the penile implant. This occurs in about 1 to 4% among low-risk patients, but can increase to 20% in high-risk patients. Infection of a penile implant is typically treated with removal of the device and a course of antibiotics. Re-implantation can be attempted 3 to 6 months later. A less invasive alternative is to use a course of antibiotics only (conservative therapy). It may be that surgical removal is not needed in all cases.

The aim of this study was to examine the outcomes of conservative therapy in treating infections of penile implants.

The records of 411 men with penile implants were examined. Of these 37 men (9%) developed an infection. 33 of the affected penile implants were malleable (semi-rigid) and 4 were inflatable implants. All men were diabetic. All 37 men were treated with conservative therapy and followed for an average of 14.6 months.

4 of the 37 men needed surgical intervention and removal of the penile implant due to failure to respond to conservative therapy. Another 2 men underwent penile implant removal due to persistent penile pain despite complete wound healing.

The remaining 31 men showed complete response to conservative therapy and resumed their normal sexual activity. The overall success rate of conservative therapy was 83.8%. The average time to complete healing (including wound closure and absence of tenderness or swelling) was 49 days.

Pseudomonas infection (a type of bacteria) was associated with the worst prognosis. All 4 cases infected with this type of bacteria failed to respond to conservative therapy. Two patients had chronic kidney failure and were on dialysis. These two patients failed to respond to conservative therapy. Age or diabetes control did not appear to affect treatment outcomes. 

Authors concluded that conservative therapy is a safe and effective treatment option for penile implant infections.

Larger studies are needed to confirm these preliminary results.