Infection outcomes after primary inflatable penile prosthesis implantation in ambulatory and hospital outpatient settings: a single-surgeon descriptive cohort.

Abstract

Device infection after inflatable penile prosthesis implantation typically mandates explantation and follows 1-3% of primary implants, a central concern as prosthetic surgery migrates to ambulatory surgery centers. We retrospectively studied all primary implantations by one surgeon while the practice operated an ambulatory program (October 2021-February 2024; the ambulatory program ended for non-clinical administrative reasons). Device, systemic prophylaxis, no-touch technique, and incision were identical between the ambulatory center and a contemporaneous hospital outpatient comparison; intraoperative irrigation was concordant between the ambulatory center and its principal hospital comparator but not across all hospital facilities. Device infection was defined as reoperation for infection within 90 days; reoperation at any interval was also screened. Of 547 primary implantations (ambulatory 218; hospital 329), no infections occurred in the ambulatory arm (0.00%, 95% confidence interval 0.00-1.68%); the hospital rate was 0.61% and the overall rate 0.37% (p = 0.52). Assignment to setting was not random, and the covariates ordinarily governing it - American Society of Anesthesiologists class, body mass index, anticoagulation, cardiopulmonary risk - were unavailable, so baseline risk cannot be assumed equal. With two events these data cannot establish non-inferiority or superiority; they characterize outcomes under one standardized protocol in two settings. These preliminary findings suggest that primary inflatable penile prosthesis implantation may be performed in an ambulatory setting without an apparent increase in infection risk when a standardized infection-prevention protocol is adopted; however, larger prospective studies are required.