Unveiling the Hidden Perils: A Comprehensive Review of Fungal Infections in Inflatable Penile Prosthesis Surgery

Area of Science:

• Urology
• Infectious Diseases
• Biomaterials Science

Background:

• Infections remain a major complication following inflatable penile prosthesis (IPP) surgery for erectile dysfunction (ED).
• Current clinical guidelines for IPP surgery lack specific recommendations for antifungal prophylaxis, despite increasing rates of fungal infections.
• Fungal biofilms on implanted devices contribute to persistent infections and treatment challenges.

Purpose of the Study:

• To review the epidemiology, risk factors, pathogenesis, and clinical manifestations of fungal infections after IPP surgery.
• To evaluate the role of antifungal prophylaxis and treatment strategies in managing post-IPP fungal infections.
• To highlight the importance of addressing fungal biofilms in preventing and treating IPP-associated infections.

Main Methods:

• Comprehensive literature review of studies on fungal infections post-IPP surgery.
• Analysis of epidemiological data, risk factors (e.g., diabetes, immunosuppression, obesity), and pathogenic mechanisms, including biofilm formation.
• Evaluation of current prophylactic and therapeutic strategies, including antibiotic and antifungal interventions.

Main Results:

• Fungal infections represent a growing concern in IPP surgery, with specific risk factors identified.
• Biofilm formation by fungi on the prosthesis is a key factor in device contamination and infection persistence.
• Prophylactic use of antifungals, combined with antibiotics, demonstrated a significant reduction (92%) in infection rates.
• Fungal infections exhibit lower salvage rates compared to bacterial infections, necessitating targeted management.

Conclusions:

• Antifungal therapy should be integrated into prophylactic protocols for IPP surgery to combat rising fungal infection rates.
• Effective management requires culture-guided treatment, surgical site irrigation, and appropriate oral antifungal medications.
• Further research into fungal biofilm mechanisms and novel biomaterials is essential for reducing infection incidence and improving patient outcomes.