Laminar Airflow in Penile Prosthesis Surgery and Infection: An Empty Systematic Review.

Area of Science:

• Urology
• Infectious Disease Prevention
• Surgical Site Infection Control

Background:

• Penile prosthesis (PP) infection is a rare but severe complication.
• Laminar airflow/ultraclean ventilation (LAF/UCV) aims to minimize airborne contaminants.
• The clinical effectiveness of LAF/UCV in preventing PP infections remains unestablished.

Purpose of the Study:

• To systematically review comparative studies on LAF/UCV versus conventional ventilation for penile prosthesis infection rates.
• To synthesize available evidence on the impact of ventilation systems on surgical outcomes in penile prosthesis surgery.

Main Methods:

• Systematic review protocol registered on PROSPERO (CRD420251128507) following PRISMA 2020/PRISMA-S guidelines.
• Comprehensive search of multiple databases (MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Dimensions) without date restrictions.
• Inclusion criteria focused on comparative studies (randomized or non-randomized) of penile prosthesis surgery comparing LAF/UCV with conventional ventilation; portable HEPA/UV recirculators were excluded.

Main Results:

• No studies met the inclusion criteria for this systematic review, resulting in an 'empty' review.
• Meta-analysis was not possible due to the absence of eligible studies.
• Indirect evidence from other surgical specialties suggests no consistent reduction in deep surgical-site infections with LAF/UCV under real-world conditions.

Conclusions:

• There is a significant lack of direct evidence evaluating LAF/UCV for penile prosthesis infection prevention.
• Current practice should emphasize multimodal infection prevention strategies and ventilation system verification.
• Future multicenter observational or trial studies are needed to provide robust data on ventilation's role and cost-effectiveness in PP surgery.