What are best practices for preventing and managing erectile implant complications, including antibiotic protocols and follow-up care?
Executive summary
Best practices to prevent and manage complications after penile prosthesis implantation center on careful patient selection and optimization, meticulous "no‑touch" sterile surgical technique with device antibiotic coatings and perioperative antimicrobial protocols, vigilant early postoperative monitoring (to catch hematoma, wound issues, or early infection), and a clear plan for conservative salvage versus explantation with staged or immediate replacement when infection occurs [1] [2] [3] [4]. Guidelines and recent reviews emphasize that infection rates are low but non‑negligible (typically 1–3%), so multidisciplinary planning and standardized follow‑up materially affect outcomes [4] [5] [6].
1. Preoperative risk reduction and patient selection
Preventing complications begins before the incision: identify appropriate candidates with a comprehensive history, physical exam and discussion of expectations; optimize comorbidities such as diabetes (HbA1c control), smoking cessation and management of immunosuppression because these factors increase infection and wound‑healing risk [1] [5]. Shared decision‑making that sets realistic expectations about outcomes and possible device limitations reduces dissatisfaction and informs consent, and some centers use preoperative preparatory measures—like short courses of vacuum therapy—to improve tissue compliance, though the evidence base varies [7] [1].
2. Intraoperative technique and antibiotic protocols
Surgeons reduce infection risk through sterile, meticulous technique—often a "no‑touch" approach combined with antibiotic‑coated implants and intraoperative irrigation with antibiotic solutions—while administering systemic perioperative antibiotics tailored to local microbiology and guidelines; these practices have driven infection rates down compared with earlier eras [7] [6] [2]. The literature supports single‑dose perioperative systemic antibiotics at induction and use of devices with antimicrobial coatings, but specific regimens vary by institution and patient allergies, and high‑quality randomized trials comparing regimens remain limited [6] [7].
3. Early postoperative care and monitoring
Early vigilance in the first days to weeks is crucial because most infections and hematomas present within three months; protocols include wound checks, activity restrictions, prompt management of bleeding or seroma, pain control, and education on signs of infection (erythema, drainage, fever) so patients present early [3] [8]. Hematoma prevention intraoperatively and recognition postoperatively reduces secondary infection risk, and standardized outpatient follow‑up schedules improve detection of device malfunction or glans problems such as ischemia or "floppy glans" syndrome tied to approach selection [8] [9].
4. Managing infections and other complications: conservative salvage versus explantation
When infection is suspected, management stratifies by severity: select cases may be treated conservatively with targeted antibiotics and device salvage techniques, but frank infections, erosion or systemic sepsis usually mandate explantation with either early replacement (salvage) or delayed reimplantation after eradication of infection; device removal is sometimes the only way to prevent progression [4] [3]. Reports and reviews note variability in salvage success and that decision‑making must weigh organism, host factors (diabetes/immunosuppression), and local tissue status—there is no one‑size‑fits‑all protocol in the literature [4] [5].
5. Long‑term follow‑up, device failure and non‑infectious complications
Longitudinal follow‑up focuses on mechanical failure, erosion, migration, persistent pain, and functional outcomes; regular assessment and patient reporting pathways allow timely revision when mechanical problems or erosion threaten tissue integrity, and counseling about the finite lifespan of devices improves realistic expectations [10] [11]. Non‑infectious complications like capsular contracture, curvature, or glans issues require individualized management—ranging from conservative measures (vacuum/traction) to revision surgery—and surveillance protocols differ across centers [12] [9].
6. Controversies, evidence gaps and institutional agendas
Although consensus reviews and specialty meetings promote antibiotic coatings and "no‑touch" techniques, controversies persist over the optimal antibiotic combinations, duration of systemic postoperative antibiotics, and criteria for early salvage versus explantation; many recommendations derive from observational series and expert consensus rather than randomized controlled trials [6] [7]. Surgical device manufacturers and high‑volume centers advocate specific coatings and approaches—an implicit commercial and institutional agenda that readers should weigh against independent data—while journals call for standardized reporting to close evidence gaps on best antimicrobial regimens and salvage algorithms [2] [5].