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

International Journal of Impotence Research (2025)Cite this article

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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.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Larkin Palm Springs Hospital, Miami, FL, USA

    Ali Fathollahi

  2. Miami Robotic Surgery, Miami, FL, USA

    Shirin Razdan

  3. International Robotic Institute for Prostate Cancer, Miami, FL, USA

    Sanjay Razdan

Authors
  1. Ali Fathollahi
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  2. Shirin Razdan
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  3. Sanjay Razdan
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Contributions

Ali Fathollahi Writing- Original draft preparation, Data curation, Formal Analysis, Writing- Review & Editing. Shirin Razdan: Review & Editing, Validation, Methodology. Sanjay Razdan: Providing the data, Writing- Review & Editing. All authors discussed the results and contributed to the final paper.

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Correspondence to Sanjay Razdan.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was granted by the Institutional Review Board of HCA Florida Kendall Hospital (IRB-41-2930). Informed consent was obtained from all individual participants included in the study. Written informed consent for publication of the clinical images (Fig. 1) was obtained from the participant.

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Fathollahi, A., Razdan, S. & Razdan, S. Zero infection protocol in inflatable penile prosthesis surgery: a prospective cohort study using chlorhexidine-alcohol skin preparation and fibrin sealant hemostasis. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01174-8

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  • DOI: https://doi.org/10.1038/s41443-025-01174-8

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