Zero-touch technique: a new paradigm in penile prosthesis surgery enabled by a sterile genital barrier system

Penile prosthesis (PP) implantation remains the most definitive treatment for medication-refractory erectile dysfunction (ED). Despite reductions in infection rates achieved through improved PP coatings, antimicrobial protocols, and refined surgical techniques, PP infection continues to impose clinical and economic burdens. To overcome these intrinsic constraints, we introduce the Zero-Touch Technique (ZTT), a fundamentally new operative paradigm enabled by a purpose-designed sterile genital barrier system. This system consists of an anatomically contoured non-adhesive penile sheath, an adhesive scrotal and suprapubic isolation layer, and lateral anchoring wings that create a 360-degree sealed sterile field. Applied immediately after antiseptic preparation and before incision, the barrier completely isolates the penis and scrotum, allowing all subsequent steps-including exposure, dilation, implantation, pump placement, and device cycling-to occur without contact with hair-bearing genital skin. ZTT has the potential to improve infection prevention in PP surgery and may contribute to establishing a new sterility standard pending further validation.