Background

Penile prosthesis implantation:

• Most popular treatment for erectile dysfunction (ED) after medical intervention.
• Relatively high infection rate (1-3%), despite best efforts to improve surgical techniques and device coatings.
• In the case of infection, the device needs to be removed – regardless of whether it will be implanted again.

Hyperbaric oxygen therapy (HBOT):

• Breathing pure oxygen in a pressurized chamber so that levels are elevated in blood and tissues.
• Enhances tissue oxygenation, promotes antimicrobial activity, immunomodulates, improves wound healing.
• Has demonstrated efficacy for treating infections and ischemia in other settings.

Study Objective

Evaluate HBOT as an adjunctive therapy for penile prosthesis infections and intraoperative complications.

Methods

• Five cases with infection or extrusion out of 166 implantations between 2022-2024.
• Patients treated with the antibiotics vancomycin and ceftazidime, and the antifungal liposomal amphotericin through an intravenous infusion until discharge.
• Revision surgery with high-pressure pulsatile lavage upon improvement of symptoms within 48-72 hours after original surgery.
• HBOT (following salvage surgery) varied according to type and severity of complication:
  • Pressure at 2.2 atm, for 60-90 minutes once per day, five days per week
  • Intraoperative complications received 20-minute sessions
  • Prosthesis infections received 30-minute sessions

Key Results/Analysis

• Two patients with scrotal pump extrusion treated conservatively with implant preservation and excision of capsule biofilm.
  • Hyperoxygenation through HBOT may enhance antibiotic activity, potentially contributing to biofilm disruption by allowing antimicrobial agents to better permeate bacterial walls.
• One patient with distal corpus cavernosum (the most forward part of erectile tissue) perforation
  • Prophylactic HBOT might help lower the risk of infection and implant extrusion, while also possibly supporting tissue regeneration, which has been associated with increased nitric oxide levels and mobilization of endothelial progenitor cells.
• Two patients required malleable implant salvage technique (MIST).
  • MIST: Removes the infected device, thoroughly washing the implant site with antibiotic irrigation to disrupt bacteria and biofilms, and immediately inserting a new, non-inflatable malleable implant.
  • One with distal crossover (both implant tubes on the same portion of erectile tissue). HBOT initiated due to purulent discharge during follow-up.
  • One with acute infection and distal cylinder extrusion (displacement or erosion of the inflatable penile prosthesis (IPP) cylinder from its normal position). Thirty (30) HBOT sessions initiated.
• Complete resolution of symptoms and preservation of prosthesis functionality for all five patients over an average 16-month follow-up period.

Clinical Takeaways

• Hyperbaric oxygen therapy may serve as an adjunctive approach to enhance treatment outcomes in penile prosthesis infections.
• HBOT could help prevent infections with surgical complications known for a high risk of contamination.
• More studies are needed for a full understanding of HBOT efficacy.

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References:

• Alabat Roca, A., Beato García, S., Etcheverry Giadrosich, B., De Fuentes Beltruz, N., Bardella Altarriba, C., Papoutsidakis, E., Castells Esteve, M., & Vigués Julià, F. (2025). Use of hyperbaric oxygen therapy as an adjuvant and preventive treatment in penile prosthesis infections. The Journal of Sexual Medicine, 22(6), 1074–1076. https://doi.org/10.1093/jsxmed/qdaf088