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Perioperative Antimicrobial Strategies in Inflatable Penile Prosthesis Surgery: Associations Between Antifungals,

Elia Abou Chawareb1, Muhammed A M Hammad1, Babak Azad2

  • 1Department of Urology, University of California, Irvine, Irvine, California.

The Journal of Urology
|August 8, 2025
PubMed
Abstract

Insights

Perioperative antifungal prophylaxis significantly reduced infection risk after inflatable penile prosthesis surgery. Oral antibiotics and prolonged IV antibiotics showed no protective effect, highlighting the need for evidence-based antimicrobial strategies.

Area of Science:

  • Urology
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Infection remains a significant complication following inflatable penile prosthesis (IPP) surgery.
  • Optimizing antimicrobial strategies is crucial for reducing IPP infection rates and improving patient outcomes.

Purpose of the Study:

  • To evaluate the association between various antimicrobial practices and infection outcomes in patients undergoing primary or revision IPP surgery.
  • To identify predictors of infection after IPP placement.

Main Methods:

  • A multicenter, retrospective cohort study involving 5261 patients across the US, Europe, and Korea (July 2016-July 2021).
  • Data collected included demographics, clinical characteristics, antibiotic/antifungal administration, and infection outcomes.
  • Univariable and multivariable regression analyses were used to identify infection predictors.

Main Results:

  • The overall infection rate was 1.9%. Higher rates were observed in diabetic patients, those with prior IPP infection, or undergoing revision surgery.
  • Diabetes and previous IPP infection were independent risk factors for infection.
  • Perioperative IV antifungal use was associated with a significantly lower infection risk (OR=0.22, P<.001).
  • Postoperative oral antibiotics and prolonged IV antibiotic prophylaxis (>24 hours) did not show protective effects.

Conclusions:

  • Perioperative antifungal prophylaxis is significantly associated with reduced infection risk in IPP surgery.
  • Preoperative and postoperative oral antibiotics, as well as prolonged IV prophylaxis, demonstrated limited utility in preventing IPP infections.
  • Findings support evidence-based antimicrobial stewardship to optimize surgical outcomes and minimize complications like antibiotic resistance.
Keywords:
antibiotics prophylaxispenile prosthesispostoperative complicationsprimary preventionprosthesis-related infections

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