Intraoperative Irrigation in Inflatable Penile Prosthesis Surgery: Past Lessons, Current Evidence, and Future...

Area of Science:

• Urology
• Surgical Innovation
• Infectious Disease Prevention

Background:

• Intraoperative irrigation is a standard practice in penile prosthesis surgery.
• The Mulcahy Salvage Protocol significantly influenced current irrigation techniques.
• Revision surgeries have a higher infection risk due to device biofilm and colonization.

Purpose of the Study:

• To review the role and evolution of intraoperative irrigation in penile prosthesis surgery.
• To highlight the importance of irrigation protocols in reducing infection rates, particularly in revision cases.
• To discuss current evidence regarding optimal irrigation solutions and those to avoid.

Main Methods:

• Review of historical and contemporary evidence on intraoperative irrigation protocols.
• Analysis of factors contributing to infection risk in revision penile prosthesis surgeries.
• Evaluation of guideline statements and multi-institutional cohort studies.

Main Results:

• Washout protocols are effective in reducing bacterial load and infectious risk.
• Vigorous mechanical lavage and antimicrobial irrigation are recommended for revision cases.
• Certain historical irrigation components, such as hydrogen peroxide and high-concentration betadine, should be avoided.

Conclusions:

• Intraoperative irrigation is essential for optimizing outcomes in penile prosthesis surgery.
• Evidence supports the use of specific irrigation protocols to mitigate infection risk.
• Further research and large-scale studies are needed to define optimal irrigation strategies.