# Periprosthetic Penile Abscess as an Unusual Cause of Refractory Urinary Tract Infection in an Elderly Patient With Diabetes: A Case Report

## TL;DR

An elderly diabetic man with a penile prosthesis developed a rare periprosthetic abscess causing a hard-to-treat urinary infection, requiring surgery for resolution.

## Contribution

Highlights periprosthetic abscess as a rare but critical cause of refractory UTIs in elderly patients with genitourinary implants.

## Key findings

- Periprosthetic abscess can develop years after penile prosthesis implantation.
- Antibiotics alone were insufficient; surgical removal of the device was necessary for recovery.
- The case emphasizes the importance of considering device-related infections in recurrent UTI cases.

## Abstract

A delayed periprosthetic abscess adjacent to a penile prosthesis, developing years after implantation, is a rare complication. We describe the case of an 81-year-old man with poorly controlled diabetes and post-stroke neurologic deficits, with a longstanding penile prosthesis, who developed an extended-spectrum beta-lactamase(ESBL) Klebsiella pneumoniae urinary infection and, subsequently, a peri-implant abscess. Despite empiric and targeted therapy, the patient deteriorated with systemic signs and progressive penile swelling until computed tomography revealed a deep periprosthetic collection. Because of the deep device focus, antibiotics alone were insufficient, prompting surgical removal of the indwelling device with debridement. This, combined with targeted therapy, led to resolution. This case underscores the need to maintain a high index of suspicion for periprosthetic infection in vulnerable elderly patients, particularly those with indwelling genitourinary devices, who present with recurrent or refractory urinary tract infections.