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Comment on: 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 (2026)Cite this article

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The study by Fathollahi et al. presents compelling data on a novel intraoperative protocol combining chlorhexidine-alcohol skin antisepsis with fibrin sealant hemostasis and drain omission, achieving an unprecedented 0% infection rate in 103 primary inflatable penile prosthesis (IPP) cases [1]. These findings meaningfully contribute to the ongoing conversation in prosthetic urology regarding best practices for minimizing surgical site infections (SSIs), particularly in high-risk populations such as diabetic and obese men.

However, as the authors themselves acknowledge, one critical limitation is the omission of detail regarding intraoperative antibiotic strategies, including both systemic (parenteral) prophylaxis and local antibiotic soak protocols used with hydrophilic-coated implants. The Coloplast Titan® inflatable penile prosthesis (Coloplast Corp., Minneapolis, MN, USA), used in this study, features a hydrophilic coating designed to absorb antibiotics—most commonly rifampin and gentamicin, though vancomycin and tobramycin have also been described depending on institutional flora and resistance patterns [2, 3]. These local antibiotic combinations have demonstrated efficacy in reducing infection by disrupting biofilm formation on prosthetic surfaces [4], and their influence is significant enough that their absence from documentation makes it difficult to attribute outcomes solely to the skin prep and hemostatic components of the protocol.

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References

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Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Robert J. Valenzuela

  2. Universidad Católica de Santiago de Guayaquil, Facultad de Ciencias de la Salud, Guayaquil, Ecuador

    Fernanda Saverio-Rodriguez

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  1. Robert J. Valenzuela
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  2. Fernanda Saverio-Rodriguez
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Contributions

RV: Conceptualization, Methodology, Validation, Writing Original Draft, Review and Editing, Supervision, Project Administration, Approval of Final Manuscript. FS: Data Curation, Visualization, Review and Editing, Supervision, and Approval of Final Manuscript.

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Correspondence to Fernanda Saverio-Rodriguez.

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Valenzuela, R.J., Saverio-Rodriguez, F. Comment on: 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 (2026). https://doi.org/10.1038/s41443-026-01258-z

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