A penile implant, or penile prosthesis, is a medical device surgically placed within the corpora cavernosa of the penis to treat severe erectile dysfunction. This device allows a man to achieve an erection on demand. While the procedure has a high satisfaction rate, infection remains the most serious complication associated with any implanted foreign body. Infection rates for first-time implants are low (typically 1% to 3%), but when infection occurs, it requires immediate medical attention. Recognizing early indicators is paramount because the infection will not resolve without intervention.
Identifying Signs and Symptoms
The first indication of infection is often localized to the surgical area. This manifests as pain that is disproportionate to the expected post-operative discomfort, or persistent pain several days or weeks after recovery. The incision site or where the device components rest may become visibly red, swollen, and warm to the touch, indicating cellulitis.
More advanced local signs include purulent drainage (pus) from the incision site, or noticeable firmness and fluctuation around the pump or reservoir. Prolonged fixation of the pump to the scrotal wall suggests tissue adherence due to inflammation. In severe, late-stage cases, the infection can cause implant components to erode through the skin.
Systemic symptoms often accompany the infection, particularly with more virulent organisms. A patient may develop a fever, chills, or a general feeling of malaise. These systemic responses signify that the body’s immune system is actively fighting a widespread infection. Any combination of localized or systemic symptoms warrants an immediate consultation with a urologist, as the infection can progress rapidly.
Understanding the Causes and Timing of Infection
The majority of penile implant infections stem from contamination by skin flora that occurs during the surgical procedure. The most common organisms involved are coagulase-negative staphylococci. These bacteria adhere to the implant’s surface and form a protective layer called a biofilm.
The formation of a biofilm shields the bacteria from the body’s immune defenses and systemic antibiotics, allowing the infection to persist. Less commonly, infection results from hematogenous seeding, where bacteria from a distant site, such as a urinary tract infection or dental abscess, travel through the bloodstream and colonize the implant.
Infections are categorized by timing. Early or acute infections account for the majority and typically occur within the first few weeks to months after the procedure, related to intraoperative contamination. Late infections surface months or years later, often due to erosion, trauma, or hematogenous spread. Risk factors that increase infection likelihood include uncontrolled diabetes, immunosuppression, and a history of prior implant surgeries or revisions.
Necessary Medical Evaluation and Diagnosis
Confirming a penile implant infection requires a thorough medical evaluation. The provider performs a focused physical exam, checking for inflammation, pain, drainage, and palpating components for adherence or fluctuation. Blood tests are routinely ordered to assess for systemic signs of infection, specifically checking the white blood cell count (WBC) and inflammatory markers like C-reactive protein (CRP).
While imaging (ultrasound or X-ray) may assess for fluid collections or device erosion, the definitive diagnostic step is obtaining a culture of the tissue or fluid surrounding the implant. This is often achieved through sterile needle aspiration of any fluid collection or a swab during an exploratory procedure. The sample is then sent for culture and sensitivity testing.
Culturing identifies the specific pathogen responsible for the infection, allowing the medical team to select the most effective, targeted antibiotics. This information is crucial for guiding the subsequent treatment protocol, including the selection of appropriate antibiotic solutions used during the surgical wash-out. The presence of even a low-virulence organism on the implant surface confirms the diagnosis and necessitates intervention.
Treatment Protocols and Device Management
Once an infection is confirmed, the device must be surgically addressed, as the established biofilm renders oral or intravenous antibiotics alone ineffective for eradication. The intervention is typically a salvage operation, aiming to clear the infection while preserving penile tissue for future device function.
Single-Stage Procedure (Immediate Salvage)
This procedure involves removing the infected device and meticulously irrigating the surgical field with antiseptic and antibiotic solutions. A new implant is placed during the same operation. This approach is successful in about 80% of cases and is preferred when the infection is less severe, localized, and involves a non-aggressive organism. The advantage is avoiding significant corporal scarring and penile shortening.
Two-Stage Procedure (Delayed Replacement)
This strategy is reserved for patients with severe, chronic, or aggressive infections, such as those with gross purulence or systemic toxicity. The entire infected implant is removed, the area is thoroughly debrided, and the patient receives a prolonged course of systemic antibiotics for several months. A new implant is placed in a subsequent surgery once the infection has fully cleared.