Preliminary Experience with a Standardized Perioperative Protocol for Infection Prevention in Inflatable Penile Prosthesis Surgery

To describe a structured, multimodal perioperative protocol for infection prevention in Inflatable penile prosthesis (IPP) surgery and report preliminary outcomes.

We retrospectively reviewed a prospectively maintained single-surgeon database of all IPP procedures performed at two XXXXXX XXXXXX hospitals between January 2017 and December 2025, classified as primary implants, removal and replacement (R/R), or component revisions (CR). Salvage procedures and explantations were excluded. A structured, protocol-driven perioperative antibiotic regimen individualized by procedure type was employed throughout, using a modified no-touch technique, copious antibiotic irrigation, a compressive mummy wrap dressing, and 23-hour inpatient observation. A Jackson-Pratt drain was placed routinely in primary cases and selectively in R/R and revision cases.

Of 487 procedures (406 primary, 58 R/R, 23 CR), one surgical site infection occurred (primary implant patient, 0.25%; 1/406), for an overall rate of 0.21% (1/487); no infections occurred in the R/R or CR groups. The infected case was managed with malleable salvage and later uncomplicated replacement. Mean age was 62.5, 63.4, and 65.2 years for primary, R/R, and revision patients, respectively. Comorbidities in the primary group included hypertension (64.5%), hyperlipidemia (60.3%), diabetes (32.3%), HIV (1.0%), and preoperative S. aureus/MRSA colonization (16.5%).

A standardized, multimodal perioperative protocol, including MRSA decolonization, chlorhexidine bathing, antimicrobial prophylaxis, no-touch technique, drain usage, and compressive dressing was associated with a very low infection rate across all procedure types, supporting further evaluation of this approach in broader settings.