Case – Conservative management of deep penile skin infection post-three-piece penile prosthesis implantation

摘要

Erectile dysfunction (ED) is the consistent inability to obtain or maintain penile erection of sufficient rigidity to permit satisfactory sexual performance for at least 3 months.1 It affects 1 in 2 males over the age of 40.1 Once reversible causes of ED have been ruled out, the treatment steps involve oral medication followed by injection therapy, urethral therapy and vacuum erection devices. Surgical penile prosthesis (PP) implantation is an excellent option and remains a very successful alternative for men with refractory ED. Every year, up to 25,000 PP implantations are performed in the United States.2 Although penile prosthesis infection (PPI) rates are less than 3% in virgin cases involving otherwise healthy patients, the rates of infection are much higher in patients who are diabetic (8%), undergoing revision surgery (10%) or on oral prednisone (20%).3 It remains the most serious post-operative complication and requires prompt surgical consultation. Historically, removal of the prosthesis followed by a long course of antibiotics and reimplantation after 3-6 months is recommended.2 In the last 20 years, the Mulcahy salvage technique, a one-stage salvage operation involving prompt removal of all hardware and several steps of antibiotic irrigation with immediate implantation of a new device, has gained popularity in similar scenarios.2,4 Recent studies have explored the role of conservative management (i.e. antibiotics) for localized/superficial infections following insertion of PP and have shown promising findings.5–8 In these circumstances, given the lack of systemic symptoms (temperature ≥38°C, leukocytosis, skin necrosis), the infection is localized in the skin and subcutaneous tissues. Therefore, rapid intervention with the appropriate antibiotics may prevent prosthesis involvement which would require surgical extraction of the device or a salvage procedure.