title: Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery.
abstract: BACKGROUND
  Penile prosthesis (PP) is the established treatment for patients with erectile dysfunction (ED) who do not respond to phosphodiesterase inhibitors and intracavernosal injections. In general, these devices have been largely successful but there are not free of serious complication such as PP infection (PPI). PPI requires immediate surgical removal or salvage rescue of the PP.
  
  
  OBJECTIVE
  In this report, we present two clinical cases with inflatable PP (IPP) treated locally with antibiotic and high pressure irrigation and then avoid the PP removal or salvage rescue.
  
  
  METHODS
  We present two patients with PPI in our institution and literature review.
  
  
  METHODS
  Resolution of the two cases.
  
  
  RESULTS
  Patient A (A) was 44 years old and patient B (B) 51 years old presented PPI after three weeks (A) and eight weeks (B). Both patients were diabetic. Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum were clean and dry. They had not scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). In both cases, we performed an excision of the tissue around the pump with a high pressure pulsed irrigation (Interpulse; Stryker Corp, Kalamazoo, MI, USA). For the irrigation we used three different solutions that included povidone-iodine, antibiotics (gentamicin plus vancomicin), and hydrogen peroxyde. Finally, we performed a multilayered surgical closure with the use of aspirate drainage over 24 hours and intravenous antibiotics. The patients had a total resolution of its symptoms after 20 months (A) and 36 months (B), and the IPP worked properly.
  
  
  CONCLUSIONS
  This treatment could be an option for to perform specific patients with local IPP infection without systemic symptoms instead of surgical removal.
authors.affiliation: Department of Urology, Hospital Universitari i Politècnic La Fe, València, Spain. Electronic address: satlujan@gmail.com.
authors.forename: Saturnino
authors.initials: S
authors.lastname: Luján
authors.affiliation: Department of Urology, Hospital Universitari i Politècnic La Fe, València, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rogel
authors.affiliation: Department of Urology, Hospital Universitari i Politècnic La Fe, València, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Broseta
authors.affiliation: Department of Urology, Hospital Universitari i Politècnic La Fe, València, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Boronat
keywords: Erectile dysfunction; Infection; Penile implantation; Penile prosthesis