(276) DISRUPTION OF BIOFILM BY LOW INTENSITY SHOCKWAVE THERAPY TO SUCCESSFULLY TREAT AN INFLATABLE PENILE IMPLANT INFECTION: THREE YEAR FOLLOW-UP

Abstract Introduction Bacterial infection of an inflatable penile implant (IPP) is usually managed by device explantation that is often associated with severe penile fibrosis and decreased length. The decision of device explantation is based on the observation that the infecting bacteria secrete an extracellular biofilm polymer matrix that protect them from systemic intravenous/oral antibiotic therapies. A variety of other infected medical devices, including breast and hip prostheses, and the lines from ventricular assist devices have been successfully treated with low intensity shockwave therapy (LiSWT). To the best of our knowledge, this is the first report of LiSWT successfully treating an infected IPP. Objective To report a case of an infected IPP successfully managed using LiSWT combined with systemic antibiotics. Methods A 49 year old patient 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. Culture of scrotal drainage prior to antibiotic administration grew serratia marcescens, enterococcus faecalis and citrobacter freundii. He was admitted for broad spectrum IV antibiotics and antifungal agents. Within 6 days, he became afebrile and WBC count normalized (8,000), however his renal and liver function tests became abnormal and he continued to have persistent scrotal drainage/device tenderness. The patient adamantly refused device explanation. He wished to try conservative treatment and was offered 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 (600 shocks each) daily for 2 weeks, twice weekly for 2 weeks, and once weekly for 4 weeks. Results At 1 week post-LiSWT and systemic antibiotic treatment, the patient remained afebrile with normal WBC count; liver and renal function tests normalized. At 2 weeks, scrotal drainage stopped. At 2.5 weeks, pain/tenderness of IPP components and scrotum stopped. At 3 weeks, inflation/deflation of the IPP occurred without pain. At 5 weeks, intercourse with orgasm was achieved. With greater than 3-year follow-up, he continues to have a fully functional, infection-free IPP. Conclusions This obvious IPP infection did not require device explanation. It is hypothesized that LiSWT induced rupture of the biofilm polysaccharide matrix, resulting in bacteria being exposed and thereby enabling systemic antibiotic therapy to access and treat the bacterial infection. LiSWT is a non-invasive, non-operative strategy that has already shown efficacy in treating other medical device infections and may be considered before performing IPP explanation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Softwave/TRT.