The Prevention and Treatment of Penile Prosthesis Infections

Since they introduction in the treatment of erectile dysfunction (ED), phosphodiesterase type 5 (PDE-5) inhibitors have achieved widespread acceptance. Today PDE-5 inhibitors are considered as first-line oral pharmacotherapy in the management of ED (Hatzimouratidis et al., 2010). However, penile implants are still a popular choice, especially in patients who have failed to achieve erections by chemical enhancement, who prefer a permanent solution to their condition or in those who have considerable scar tissue in the penis resulting in erection deformalities (Mulcahy 1999). Despite its invasiveness, penile prostheses provide high satisfaction rates (Montague & Angermeier 2001). The types of prosthesis most commonly implanted are the two-piece and the three-piece inflatable device, and the soft and malleable prosthesis. In the last few years the threepiece inflatable device has been used for preference, as it improves the erection with the most acceptable functional and cosmetical results (Minervini et al., 2006; Bettocchi et al., 2008). Engineering changes and designs revisions have reduced the mechanical malfunctions associated with inflatable penis prostheses to less than 5 % (Carson et al., 2000; Carson 2004). As penile prostheses are now expected to function for an average of 8-12 years post implantation, infection has become a more significant problem. The incidence of infection has been reported to range from 0.5 to 17.7% (Quesada & Light, 1993; Wilson & Delk, 1995) usually about 1-3 % in case of primary implantation, and about 10-13 % in case of revision or reimplantation (Abouassaly et al., 2004). The traditional treatment of penile prosthesis infection is systematic and local antibiotics application with the complete removal of the device followed by reinsertion within 2–12 months. However, removal of the device can lead to corporeal fibrosis, making dilation of the corporeal bodies difficult and reinsertion of a new device more complicated (Brant et al., 1996; Mulcahy, 1999). To reduce the risk of device associated infections and to avoid the difficulties associated with late reinsertions many modifications have been developed such as antibiotic or hydrophilic coated devices and immediate replacement of the infected prosthesis (salvage techniques).