Abstract Introduction The prevalence of infection with inflatable penile implant (IPP) varies from 1-3%, usually managed by device explantation, and if appropriate, salvage surgery. Despite salvage surgery about 20% remain infected requiring additional antibiotics and surgery. The problem in part is that infecting bacteria secrete an extracellular biofilm polymer matrix that protect them from systemic intravenous/oral antibiotic therapies. Low intensity shockwave therapy (LiSWT) has been shown to disrupt biofilm, hypothetically allowing antibiotics to reach the infection and lower salvage re-infection. Objective Based on two cases of infected IPPs, the aim of this study is to test the hypothesis that penile implant infections could be managed by combining LiSWT combined with systemic antibiotics, and device explantation/implantation as needed. Methods Case #1 (49 yo) presented 4 weeks post-operatively with an obvious IPP infection: fever (101°F), elevated WBC count (15,400), purulent drainage from a swollen, tender scrotum, and IPP device tenderness. He was admitted for broad spectrum IV antibiotics and antifungal agents, however his liver enzyme function tests were abnormal at 6 days. He was afebrile, WBC count normalized (8,000), with persistent scrotal drainage/device tenderness. The patient adamantly refused device explanation, wishing only conservative treatment with daily LiSWT combined with oral levofloxacin. LiSWT (SoftWave TRT/Urogold 100 MTS, energy flux density 0.13 mJ/mm2, Hz 3.0) was applied to the reservoir, penile shaft and scrotum (2000 shocks each) daily for 2 weeks, twice weekly for 2 weeks, and once weekly for 4 weeks. Case #2 (72 yo) presented 3 months post-operatively with a scrotal pinpoint opening with purulent drainage. He had mild device tenderness but was afebrile. He was admitted for broad spectrum IV antibiotics and antifungal agents, however, drainage persisted and he underwent device explantation/implantation. He underwent daily post-op LiSWT to the reservoir, penile shaft and scrotum (2000 shocks each) daily for 1 week combined with oral antibiotics. Results At 1 week combined post-LiSWT and systemic antibiotic treatment, both patients remained afebrile with normal WBC count. At 2 weeks, scrotal drainage stopped for the first case and at 3 weeks, inflation/deflation of the IPP occurred without pain. With greater than 5-year follow-up for case 1 and 1-year follow up for case 2, both patients have fully functional, infection-free implants. Conclusions LiSWT is a non-invasive, non-operative strategy that has already shown efficacy in treating medical device (breast, hip, dental) infections. The results of these cases suggest that LiSWT applied after salvage surgery disrupts residual biofilm, allowing systemic antibiotics to be more effective, thereby reducing rates of second infection after salvage surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Softwave/MTS
I Goldstein (Mon,) studied this question.