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

Penile prosthesis (PP) infection is uncommon but serious. Laminar airflow/ultraclean ventilation (LAF/UCV) aims to reduce airborne bioburden, but its clinical impact on PP infection is unclear. We registered a protocol in PROSPERO (CRD420251128507) and followed PRISMA 2020/PRISMA-S, searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL, CINAHL, and Dimensions (no date limits), screening reference lists/forward citations, and reviewing professional guidance. Eligible studies were randomised or non-randomised comparative PP studies reporting infection by LAF/UCV versus conventional ventilation; portable high-efficiency particulate air (HEPA)/UV recirculators were excluded a priori. Two reviewers independently screened the results; meta-analysis was prespecified if appropriate, otherwise a narrative synthesis was used. Of 99 records (98 databases; 1 other), 26 duplicates were removed; 72 titles/abstracts were screened; 2 full texts were assessed. As a result, no study met the inclusion criteria, and no meta-analysis was possible. Indirect evidence from orthopaedic, breast, vascular, and cardiac surgery shows no consistent reduction in deep surgical-site infection with LAF compared with conventional ventilation under real-world conditions where unidirectionality can be disrupted by door openings, staff/equipment movement, and thermal plumes. Evidence from other specialties is indirect and of uncertain applicability to penile prosthesis surgery. No eligible comparative penile prosthesis studies evaluating LAF/UCV versus conventional ventilation were identified; this is therefore an empty systematic review. Pending procedure-specific data, practice should prioritise multimodal infection-prevention bundles (e.g., antibiotic prophylaxis, "no-touch" technique, traffic control) and verification of ventilation performance during live use; future multicentre observational studies or cluster/stepped-wedge trials should prospectively capture ventilation parameters and key confounders to enable robust comparisons and cost-effectiveness analyses.