Zero infection protocol in inflatable penile prosthesis surgery: a prospective cohort study using chlorhexidine-alcohol skin preparation and fibrin sealant hemostasis.

Abstract

Surgical site infections remain a devastating complication of inflatable penile prosthesis (IPP) implantation. We evaluated a novel surgical protocol combining chlorhexidine-alcohol skin preparation with fibrin sealant-mediated hemostasis and no drain placement, hypothesizing that it would reduce infection and hematoma rates. Between January 2020 and December 2023, 103 men underwent primary IPP placement with a protocol of 2% chlorhexidine gluconate/70% isopropyl alcohol (ChloraPrep®) skin antisepsis and intraoperative application of Evicel® fibrin sealant to corporotomy suture lines, subcutaneous tissues, and pump pocket. This group was compared with 115 historical controls who received povidone iodine skin preparation only and routine surgical drains between January 2015 to December 2019. The primary endpoint was IPP infection at 12 months; secondary endpoints included hematoma rate, operative time, length of stay, and patient satisfaction. No infections occurred in the study cohort (0/103), compared to 3.5% (4/115) of controls (p < 0.001). Hematoma incidence was 1.0% (1/103) versus 5.2% (6/115) in controls (p = 0.03). Mean operative time (52.4 ± 13.8 min vs. 58 ± 18 min, p = 0.12) was similar between groups, while same-day discharge rates were higher in the study cohort (94.7 vs. 88.0%, p = 0.03). Combining chlorhexidine-alcohol skin antisepsis with fibrin sealant hemostasis and eliminating drains is a viable option to reduce infections and hematomas in IPP surgery.