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<p>Surgical site infection (SSI) remains a serious complication of penile prosthesis implantation despite established preventive strategies. This prospective single-center randomized clinical study evaluated the clinical relevance of pre-antisepsis penoscrotal skin swabbing in men undergoing malleable penile prosthesis implantation by assessing organism-level concordance, defined as species-level matching between preoperative penoscrotal swab isolates and postoperative infection-site cultures in patients who developed SSI, based on routine phenotypic microbiological identification. A secondary objective was to compare chlorhexidine gluconate (CHG) and povidone–iodine (PVI) with respect to downstream postoperative outcomes. Between October 2023 and February 2024, 135 men undergoing malleable penile prosthesis implantation at a single tertiary referral center were randomized 1:1 using a computer-generated block randomization sequence to CHG (<i>n</i> = 69; 2% chlorhexidine in 70% alcohol) or PVI (<i>n</i> = 66; 10% povidone–iodine). Preoperative penoscrotal swabs were obtained before surgical skin antisepsis, and all patients completed standardized 12-month follow-up. SSI occurred in 15/135 patients (11.1%). Organism-level concordance between preoperative swab isolates and postoperative infection-site cultures was observed in 11/15 infected patients (73.3%; 95% confidence interval, 45.0–92.2%). Staphylococcus epidermidis was the most frequent concordant organism, with matching preoperative and postoperative isolates in 7/9 postoperative S. epidermidis infections (77.8%; p = 0.02). Overall SSI rates did not differ significantly between CHG and PVI groups (8.7% vs 13.6%, <i>p</i> = 0.42). However, compared with CHG, the PVI group showed earlier infection onset (4 ± 1 vs 6 ± 2 days, p = 0.03), higher postoperative bacterial colony counts (3.8 × 10⁵ ± 0.7 × 10⁵ vs 1.8 × 10⁵ ± 0.4 × 10⁵ CFU/mL, p = 0.01), and longer epithelialization time (10.4 ± 2.1 vs 9.2 ± 1.8 days, p = 0.03). These findings suggest that preoperative penoscrotal swabbing may provide clinically relevant microbiological information in higher-risk malleable penile prosthesis candidates, while CHG-based antisepsis may enhance bacterial suppression and wound healing.</p>

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Preoperative penoscrotal swab microbiology and postoperative infection concordance in malleable penile prosthesis surgery: A prospective randomized study of skin antisepsis

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Adham AbdelKader,
  • Mohammed A. Abdel-Rassoul,
  • Galal El Shorbagy,
  • Nadia Mohammed Hassan Madany,
  • Hesham Torad

摘要

Surgical site infection (SSI) remains a serious complication of penile prosthesis implantation despite established preventive strategies. This prospective single-center randomized clinical study evaluated the clinical relevance of pre-antisepsis penoscrotal skin swabbing in men undergoing malleable penile prosthesis implantation by assessing organism-level concordance, defined as species-level matching between preoperative penoscrotal swab isolates and postoperative infection-site cultures in patients who developed SSI, based on routine phenotypic microbiological identification. A secondary objective was to compare chlorhexidine gluconate (CHG) and povidone–iodine (PVI) with respect to downstream postoperative outcomes. Between October 2023 and February 2024, 135 men undergoing malleable penile prosthesis implantation at a single tertiary referral center were randomized 1:1 using a computer-generated block randomization sequence to CHG (n = 69; 2% chlorhexidine in 70% alcohol) or PVI (n = 66; 10% povidone–iodine). Preoperative penoscrotal swabs were obtained before surgical skin antisepsis, and all patients completed standardized 12-month follow-up. SSI occurred in 15/135 patients (11.1%). Organism-level concordance between preoperative swab isolates and postoperative infection-site cultures was observed in 11/15 infected patients (73.3%; 95% confidence interval, 45.0–92.2%). Staphylococcus epidermidis was the most frequent concordant organism, with matching preoperative and postoperative isolates in 7/9 postoperative S. epidermidis infections (77.8%; p = 0.02). Overall SSI rates did not differ significantly between CHG and PVI groups (8.7% vs 13.6%, p = 0.42). However, compared with CHG, the PVI group showed earlier infection onset (4 ± 1 vs 6 ± 2 days, p = 0.03), higher postoperative bacterial colony counts (3.8 × 10⁵ ± 0.7 × 10⁵ vs 1.8 × 10⁵ ± 0.4 × 10⁵ CFU/mL, p = 0.01), and longer epithelialization time (10.4 ± 2.1 vs 9.2 ± 1.8 days, p = 0.03). These findings suggest that preoperative penoscrotal swabbing may provide clinically relevant microbiological information in higher-risk malleable penile prosthesis candidates, while CHG-based antisepsis may enhance bacterial suppression and wound healing.