Procedure

Penile Prosthesis Salvage Surgery

Penile prosthesis salvage surgery is an infection-control operation in which an infected penile implant is removed, the prosthetic spaces are thoroughly cleaned and irrigated, and a new penile prosthesis is implanted during the same operation when clinically appropriate. The aim is to eradicate infection while preserving corporal space, penile anatomy and the possibility of continued prosthesis function without waiting months for delayed reimplantation.

AnaesthesiaGeneral

Operating time120–240 min

Hospital stay1–3 nights

Days in Türkiye7–14 days

Back to work2–4 weeks

Medically reviewed by Dr. Elif Yılmaz, MD, FECSM

Last reviewed 23 August 2026

✓ Clinician reviewed

✓ Clinician-reviewed information

Key takeaways

Penile prosthesis salvage surgery treats an infected penile implant by removing the infected device, performing extensive surgical washout and immediately placing a new prosthesis in selected patients.
Immediate salvage can avoid the months-long implant-free period associated with removal followed by delayed reimplantation.
Published evidence reports infection-free salvage outcomes above 80% in appropriately selected patients, although results vary between studies and patient groups.
Either an inflatable or malleable prosthesis may be used during salvage, with malleable implants increasingly used as a temporary or definitive option.
Not every infected penile implant is suitable for immediate salvage; severe systemic infection, tissue necrosis, extensive erosion or unstable medical conditions can change the treatment strategy.

About penile prosthesis salvage surgery

Penile prosthesis salvage surgery is a specialized operation used to manage infection of a penile implant.

Traditionally, an infected prosthesis was completely removed and the patient waited for the infection and tissues to heal before receiving another implant months later.

The problem with this approach is that the corporal spaces that previously contained the implant can develop substantial scar tissue after removal.

This may lead to:

Corporal fibrosis
Loss of corporal space
Penile shortening
More difficult future implantation
Need for narrower cylinders
More complex reconstructive surgery

Immediate salvage was developed to address these problems.

During salvage surgery, the infected prosthesis is removed, contaminated tissue and prosthetic spaces are thoroughly cleaned, and a new prosthesis is implanted during the same operation when the clinical situation permits.

The European Association of Urology recognizes immediate salvage with washout and replacement as an alternative management strategy for penile prosthesis infection, with successful salvage reported in more than 80% of cases.

What is an infected penile prosthesis?

A penile prosthesis infection occurs when microorganisms colonize the implant or surrounding surgical tissues.

Because the prosthesis is a foreign body, bacteria can adhere to its surface and form a biofilm.

Biofilm can make prosthetic infections difficult to eradicate using antibiotics alone.

This is why established penile implant infection generally requires surgical management rather than simply prescribing antibiotics and leaving the infected device in place.

What are the signs of penile implant infection?

Possible signs include:

Persistent or increasing penile pain
Scrotal pain
Redness
Swelling
Wound drainage
Pus or abnormal discharge
Incision breakdown
Implant exposure
Pump fixation to the scrotal skin
Fever
Chills
Increasing tenderness
Erosion
Persistent unexplained discomfort around the prosthesis

Some infections are obvious and acute.

Others are more indolent and may present with persistent pain, pump adherence to the skin or subtle wound changes.

A suspected infection should be evaluated promptly by a prosthetic urologist.

Why aren't antibiotics alone enough?

Antibiotics are an important part of treatment, but an established prosthetic infection is difficult to cure while contaminated foreign material remains inside the body.

Bacteria can attach to the implant surface and develop protective biofilm.

Consequently, treatment generally requires removal of the infected prosthetic material in addition to antimicrobial therapy.

The EAU states that prosthetic infection requires prosthesis removal and antibiotics, with immediate salvage and replacement being an alternative in selected patients.

What happens during salvage surgery?

The precise protocol varies between surgeons and clinical situations.

In general, the surgeon:

Exposes and removes the infected prosthesis.
Removes contaminated foreign material.
Inspects the corporal spaces and surrounding tissues.
Obtains cultures when clinically appropriate.
Removes unhealthy or infected tissue where necessary.
Performs extensive irrigation/washout of the prosthetic spaces.
Reassesses tissue viability and infection extent.
Places a new penile prosthesis when immediate reimplantation is considered appropriate.
Provides antimicrobial treatment based on the clinical situation and microbiological findings.

The replacement device may be inflatable or malleable.

What is the Mulcahy salvage procedure?

The Mulcahy salvage procedure is the classic approach associated with immediate treatment of penile prosthesis infection.

The fundamental concept is:

Remove infected prosthetic material → extensively irrigate the implant spaces → immediately place a new prosthesis.

The technique was developed to avoid delayed reimplantation and the fibrosis and penile shortening that may follow prolonged absence of a device.

Long-term experience with the original approach reported infection-free outcomes in approximately 82% of evaluated patients.

Modern salvage surgery has evolved considerably, and individual surgeons may modify irrigation solutions, antimicrobial protocols, device choice and operative technique.

What is malleable implant salvage?

Instead of immediately replacing an infected inflatable penile prosthesis with another inflatable system, the surgeon may insert a malleable penile prosthesis after removing the infected device and completing washout.

This approach is sometimes called the malleable implant salvage technique.

A malleable prosthesis has fewer components than an inflatable system and avoids immediate replacement of the scrotal pump and abdominal/pelvic reservoir.

It also maintains corporal space while the patient recovers.

A multicenter study of 58 men undergoing infected inflatable prosthesis removal followed by malleable salvage reported that 54 of 58 patients (93%) remained infection-free.

Is the malleable implant temporary?

Not necessarily.

Some patients are satisfied with the malleable prosthesis and choose to keep it permanently.

Others later choose conversion to an inflatable penile prosthesis.

In the multicenter malleable-salvage study, 17 of the 54 infection-free patients subsequently underwent conversion to an inflatable prosthesis, on average 6.7 months after salvage.

Therefore, malleable salvage can function as either:

A definitive penile prosthesis
A space-preserving bridge to later inflatable implantation

Can an inflatable implant be placed immediately?

Yes, selected patients may undergo removal of an infected prosthesis, washout and immediate implantation of a new inflatable penile prosthesis.

The decision between inflatable and malleable salvage depends on factors including:

Extent of infection
Tissue quality
Corporal fibrosis
Previous operations
Surgeon experience
Patient preference
Device availability
Overall medical condition

No single salvage strategy is appropriate for every patient.

Why avoid delayed reimplantation when possible?

If an infected prosthesis is removed without immediate replacement, the empty corporal spaces can contract and scar.

This may cause:

Corporal fibrosis
Loss of penile length
More difficult dilation
Increased technical difficulty during later implantation
Need for smaller or narrower cylinders

Immediate salvage attempts to preserve the space previously occupied by the implant.

A 2025 review emphasizes preservation of penile length and avoidance of difficult delayed reimplantation among the potential advantages of immediate salvage.

Is salvage always possible?

No.

The surgeon must determine whether immediate replacement is safe and technically appropriate.

Factors such as severe systemic illness, extensive tissue destruction, necrosis, severe erosion or other high-risk findings may favor explantation without immediate replacement.

Older literature identified sepsis, ketoacidosis, penile necrosis and bilateral urethral cylinder erosion among important relative contraindications to salvage. Modern practice has expanded salvage candidacy in some centers, but patient selection remains individualized.

Salvage surgery vs revision surgery

These are related but different procedures.

Penile Prosthesis Revision Surgery primarily addresses problems such as:

Mechanical failure
Device malfunction
Malposition
Cylinder problems
Pump problems
Reservoir problems

Penile Prosthesis Salvage Surgery specifically addresses:

prosthesis infection requiring removal, washout and potential immediate replacement.

Keeping these as separate pages is appropriate clinically and for search intent.

Outcomes

A 2024 systematic review found that published penile prosthesis salvage studies reported success rates of approximately 80% to 100%, with overall evidence supporting infection-free salvage rates above 80% in appropriately selected patients.

Source: pubmed.ncbi.nlm.nih.gov

Who it is for

✓ May be suitable if

•You have a confirmed or strongly suspected penile prosthesis infection requiring surgical treatment.
•Your infected prosthesis needs to be removed and the surgeon believes immediate replacement may be safely attempted.
•You have persistent implant-related pain accompanied by clinical findings suggesting infection.
•You have wound drainage or other local evidence of prosthesis infection without a contraindication to immediate salvage.
•Your implant is infected but penile and corporal tissues remain sufficiently viable for reconstruction.
•You want to preserve corporal space and avoid delayed reimplantation when immediate salvage is medically appropriate.
•You understand that the replacement prosthesis may need to be malleable rather than inflatable depending on operative findings.
•You are medically stable enough to undergo anesthesia and reconstructive prosthetic surgery.
•You understand that salvage can fail and that complete device removal may still become necessary.

✕ Not suitable if

•You are medically unstable or have uncontrolled sepsis requiring urgent stabilization.
•There is extensive penile tissue necrosis that makes immediate prosthesis replacement unsafe.
•Severe urethral injury or extensive prosthesis erosion prevents safe immediate reimplantation.
•The infection has caused tissue destruction that cannot adequately support a replacement prosthesis.
•You have uncontrolled diabetic ketoacidosis or another serious metabolic emergency.
•Your anesthetic or surgical risk is currently unacceptable.
•The surgeon determines during surgery that adequate infection control or tissue viability cannot be achieved.
•You expect salvage surgery to guarantee preservation or enlargement of penile length.
•You are unwilling to accept the possibility that the implant may need to be completely removed without immediate replacement.
•You have symptoms of severe systemic infection and are planning to delay urgent local medical care in order to travel abroad.

Preparing for surgery

Contact a prosthetic urologist promptly if penile implant infection is suspected.

Send the original implant operative report if available.

Provide the implant card, manufacturer and model.

Send reports from previous revision or implant operations.

Report fever, chills, drainage, wound opening, redness, swelling or device exposure.

Provide details of all antibiotics recently taken.

Send any available wound, urine or blood culture results.

Inform the team about diabetes and provide recent glucose and HbA1c results when available.

Provide a complete medication list.

Tell the medical team about anticoagulants and antiplatelet medications.

Do not independently stop prescribed anticoagulants; follow medical instructions.

Complete blood tests and urine testing requested by the surgical team.

Follow fasting instructions before anesthesia.

Do not manipulate, squeeze or attempt to drain an infected wound yourself.

Arrange sufficient time in Turkey for postoperative surveillance before returning home.

What recovery looks like

Day 0 — Salvage surgery

The infected prosthesis is removed, the prosthetic spaces are surgically cleaned and irrigated, and a replacement prosthesis is inserted if immediate salvage remains appropriate after direct assessment of the tissues. The patient is monitored closely after anesthesia, and antimicrobial treatment is continued according to the clinical situation and surgeon's protocol.

Days 1–3 — Early postoperative monitoring

Penile and scrotal swelling, bruising, tenderness and incisional discomfort are expected during the first few days. Because the operation was performed for infection, the medical team pays particular attention to temperature, wound appearance, drainage, pain progression and other signs of persistent infection. Culture results, when obtained, may also influence antimicrobial treatment.

Days 4–7 — Infection and wound reassessment

During the first postoperative week, swelling and discomfort should gradually begin to improve. The surgeon reviews the incision and surrounding tissues for recurrent redness, drainage, wound separation, erosion or other evidence that infection has not been controlled. International patients should remain accessible to the surgical team during this important early surveillance period.

Week 2 — Early healing

By the second week, uncomplicated patients should experience progressive improvement in pain, swelling and mobility. Light daily activities and desk-based work may become possible for some men, but strenuous activity and pressure on the operative area remain restricted. Any new fever, increasing pain, drainage or worsening redness requires prompt reassessment.

Weeks 3–4 — Continued tissue recovery

Healing continues during weeks three and four, and most uncomplicated wounds should be substantially improved. Physical activity can gradually increase according to the surgeon's instructions, but heavy lifting, cycling, strenuous exercise and sexual activity are usually still restricted while the prosthesis and surrounding tissues continue to stabilize.

Weeks 4–6 — Prosthesis management

If an inflatable prosthesis was placed, activation and cycling may begin once the surgeon confirms adequate healing and infection control. If a malleable prosthesis was used, the surgeon provides instructions regarding positioning and daily management. The exact timing varies considerably after salvage surgery and should not be forced according to a fixed calendar.

Week 6 and beyond — Return to sexual activity

Sexual activity may gradually resume once the wounds have healed, infection has resolved, discomfort is minimal and the surgeon confirms that prosthesis use is safe. Patients with complicated infection, erosion, extensive reconstruction or delayed wound healing may need considerably longer before intercourse.

Several months later — Optional conversion after malleable salvage

Patients who received a malleable prosthesis as part of salvage may choose to keep it permanently or later consider conversion to an inflatable device. In one multicenter series, patients who elected conversion underwent inflatable prosthesis placement an average of 6.7 months after successful malleable salvage.

Risks and complications

Persistent or recurrent infection

The most important risk is failure to eradicate the infection. If infection persists or returns, the replacement prosthesis may need to be removed and additional surgery or antimicrobial treatment may be required.

Complete implant removal

Even when immediate salvage is planned, operative findings may make safe reimplantation impossible. The surgeon may therefore need to remove the infected prosthesis without placing another device during the same operation.

Erosion or extrusion

The replacement prosthesis can erode through corporal, urethral, glanular, penile or scrotal tissues, particularly when tissue quality has already been compromised by infection.

Corporal fibrosis

Infection, previous surgery and prosthesis removal can cause scar formation inside the corpora. Severe fibrosis may make future implantation more difficult.

Penile shortening

Some patients experience actual or perceived penile shortening following infection, explantation, fibrosis or repeated prosthetic surgery. Salvage attempts to preserve corporal space but cannot guarantee preservation of previous penile dimensions.

Mechanical failure

The replacement prosthesis remains a mechanical medical device and may eventually develop cylinder, pump, reservoir, tubing or other component failure.

Urethral injury

Removal and replacement of prosthetic cylinders in infected or scarred tissue can increase the risk of urethral injury.

Bleeding or hematoma

Bleeding can produce penile or scrotal hematoma and may occasionally require additional treatment.

Wound healing problems

Infection and repeated surgery increase the possibility of delayed wound healing, wound separation, drainage or skin complications.

Pain

Postoperative pain is expected initially. Persistent or worsening pain can indicate infection, device positioning problems or another complication and requires reassessment.

Need for additional surgery

Some patients require another operation because of recurrent infection, erosion, mechanical failure, conversion from malleable to inflatable prosthesis or another complication.

Common questions

What is penile prosthesis salvage surgery?

Penile prosthesis salvage surgery removes an infected penile implant, thoroughly cleans the prosthetic spaces and places a new implant during the same operation when immediate replacement is considered safe.

What is the Mulcahy salvage procedure?

The Mulcahy salvage procedure is the classic immediate salvage strategy for penile prosthesis infection. It involves removal of infected prosthetic material, extensive surgical washout and immediate implantation of a new prosthesis.

What is the success rate of penile implant salvage surgery?

A 2024 systematic review found published success rates ranging from approximately 80% to 100%, although outcomes vary considerably between techniques, patient groups and definitions of success.

Does the infected penile implant have to be removed?

Established prosthesis infection generally requires removal of the infected device and antimicrobial treatment. Immediate salvage differs from simple explantation because a new prosthesis is placed during the same operation when appropriate.

Can antibiotics cure an infected penile implant without surgery?

Antibiotics alone are generally insufficient for an established prosthetic infection because microorganisms can adhere to the device and form biofilm. Antibiotics are important, but surgical removal of infected foreign material is typically required.

Can a new penile implant be placed immediately after removing the infected one?

Yes, in selected patients. This is the basis of immediate penile prosthesis salvage surgery.

Why not simply remove the implant and wait?

Delayed reimplantation remains an option, but removing the device without immediate replacement can allow corporal fibrosis and contraction to develop, potentially causing shortening and making later implantation more difficult.

What type of implant is used during salvage?

A new inflatable prosthesis or a malleable prosthesis may be used depending on the infection, tissue condition, surgeon's approach and patient factors.

Why would a malleable implant be used?

A malleable implant has fewer components and can maintain corporal space after removal of an infected inflatable system. It may be retained permanently or replaced with an inflatable prosthesis later.

How successful is malleable penile implant salvage?

A multicenter study of 58 men reported that 54 patients, or 93%, remained infection-free after infected inflatable prosthesis removal and malleable salvage.

Can the malleable implant later be changed to an inflatable implant?

Yes. In the same multicenter series, 17 infection-free patients later underwent conversion to an inflatable prosthesis, at an average of 6.7 months after salvage.

Is a malleable implant always temporary after salvage?

No. Some patients choose to keep the malleable implant permanently.

Can salvage surgery fail?

Yes. Persistent or recurrent infection can occur, and the replacement prosthesis may ultimately need to be removed.

Is everyone with an infected implant suitable for immediate salvage?

No. Tissue viability, systemic illness, erosion, necrosis, metabolic stability and other factors must be considered individually.

Can I have salvage surgery if I have diabetes?

Diabetes does not automatically exclude salvage, but glucose control and overall infection risk require careful assessment. Individual candidacy should be determined by the treating surgeon.

How long does penile prosthesis salvage surgery take?

Approximately 2–4 hours is a reasonable planning range, although operative time varies according to infection severity, previous surgery, fibrosis, erosion and reconstruction requirements.

How long should I stay in Turkey?

For an international patient, approximately 7–14 days is a reasonable planning range after salvage surgery, but infection severity and postoperative progress can require a longer stay.

When can I return to work?

Some patients with desk-based work may return in approximately 2–4 weeks, while strenuous occupations commonly require longer.

When can I have sex after salvage surgery?

Sexual activity should wait until infection has resolved, wounds have healed and the surgeon has cleared prosthesis use. Six weeks or longer may be required, particularly after complicated infection.

Can salvage surgery restore lost penile length?

The objective is infection control and preservation of prosthetic function and corporal space. It should not be marketed as a penile-lengthening procedure and cannot guarantee restoration of lost length.

What happens if salvage is not possible?

The infected prosthesis may need to be completely removed. Reimplantation can then be considered after the infection and tissues have healed, although subsequent surgery may be more difficult because of fibrosis.

Can I fly to Turkey if my penile implant is infected?

Planned international treatment may be possible for a medically stable patient after specialist assessment. However, fever, severe systemic illness, rapidly worsening redness or swelling, tissue necrosis or signs of sepsis require urgent local medical care rather than delaying treatment to travel.

Which surgeon should perform penile implant salvage?

The procedure should ideally be performed by a urologist or andrologist with substantial experience in penile prosthetic surgery, implant infections, revision surgery and complex reconstruction.

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Sources

European Association of Urology — Sexual and Reproductive Health Guidelines https://uroweb.org/guidelines/sexual-and-reproductivehealth/chapter/management-of-erectile-dysfunction
Salvage procedures for infected penile implants: A comprehensive review and analysis of functional outcomes https://pubmed.ncbi.nlm.nih.gov/38697265/
A multicenter study of 58 patients reported a 93% infection-free rate following malleable salvage. https://pubmed.ncbi.nlm.nih.gov/26343986/
Long-term experience with immediate salvage reported 82% of evaluated patients without signs of infection. https://pubmed.ncbi.nlm.nih.gov/10647660/
Contemporary review of immediate salvage, surgical innovations and antimicrobial strategies. https://pubmed.ncbi.nlm.nih.gov/40707690/
Review of the development and evolution of penile prosthesis salvage. https://pubmed.ncbi.nlm.nih.gov/35027720/