Prevenzione delle infezioni protesiche peniene: lezioni dalla prima linea della chirurgia ortopedica

Ultimo aggiornamento: Agosto 15, 2026

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For men with erectile dysfunction that has not responded to medication, a penile prosthesis can be a life-changing operation. The shadow hanging over it is infezione. During my time as a Research Scholar and Clinical Observer at the Scott Department of Urology, Baylor College of Medicine, working alongside Professor Mohit Khera, I have seen how serious that complication is: an infected device usually has to be removed and replaced at a second operation.

A note on who this article is for. Most of what follows is written for colleagues — targets, thresholds and operating-theatre detail. I have left it that way deliberately, because patients are entitled to see what their surgeon is actually thinking about rather than a simplified version. If you are reading this as a patient, the practical section near the end is the part that concerns you, and nothing here should be acted on without your own doctor.

To push the risk down further, urologists have been looking toward colleagues in orthopaedic surgery. Why? Because orthopaedic surgeons have been refining implant success for decades. Whether it is a titanium hip or a silicone penile cylinder, the body’s biological response to a foreign object is remarkably similar. By adopting the protocols used to prevent periprosthetic joint infections, we can improve the safety and longevity of penile implants.

Why Borrow from Orthopaedic Surgery?

Below is a comparison of the most useful orthopaedic strategies and how they translate into penile prosthesis surgery. Worth saying plainly: most of these are extrapolated from joint replacement rather than proven in penile implant trials. The biology is close enough to be persuasive, and that is not the same as proof.

Strategy	Orthopaedic application	Potential benefit in urology
Glycaemic control	HbA1c < 7%; glucose < 180 mg/dL	Faster wound healing; reduced bacterial fuel
Decolonisation	Nasal mupirocin & chlorhexidine washes	Removes carriage from the patient’s own skin and nose
Smoking cessation	6-week pre-op stop; cotinine testing	Restores blood flow and oxygen to the surgical site
Sterile barriers	Double gloving & gown-glove sealing	Prevents microscopic contamination from the surgical team
Theatre discipline	Hourly suction tip changes; low traffic	Reduces airborne bacteria in the operating room

1. Preoperative Optimisation: Winning Before the First Incision

In orthopaedics, surgery is the culmination of a preparation phase. The pre-habilitation of a patient matters as much as the operation.

Medical and Glycaemic Control

Patients with diabetes are at higher risk of infection, because high blood sugar impairs the immune system’s ability to fight bacteria.

• The usual threshold: orthopaedic data supports achieving an HbA1c below 7% before elective surgery.
• A shorter yardstick: HbA1c reflects roughly three months, so some specialists also look at fructosamine, which captures more recent control.
• Postoperative stability: keeping blood glucose below 180 mg/dL after surgery matters as much as the number beforehand.

Lifestyle: Smoking and Alcohol

Smoking is perhaps the greatest enemy of wound healing. Nicotine constricts blood vessels, starving the surgical site of the oxygen and nutrients needed to repair tissue.

• The six-week rule: orthopaedic surgeons often require patients to stop smoking at least six weeks before surgery, sometimes verifying with urine cotinine testing.
• Alcohol: heavy intake suppresses the immune system and complicates anaesthesia and healing.

Decolonisation: Clearing the Pathogen Reservoir

Bacteria live harmlessly on skin and in the nose until an incision provides a doorway.

• Nasal decolonisation: many orthopaedic protocols use mupirocin ointment in the nose to reduce Staphylococcus aureus carriage.
• Body washing: patients are often asked to use chlorhexidine gluconate washes for several days before surgery to reduce the bacterial load on the skin.

These are prescribed and timed by the surgical team, not bought and started independently. Mupirocin is a prescription antibiotic, and using it without indication contributes to resistance; chlorhexidine washes have their own instructions and can irritate skin. If your operation is being planned, ask what your hospital’s protocol is rather than assembling one yourself.

Nutritional Support

A malnourished body does not heal well. Markers used to judge whether a patient is biologically ready for an implant include:

• Albumin: a serum albumin below 3.5 g/dL is a warning sign of poor nutritional status and higher infection risk.
• Immune competence: a total lymphocyte count below 1,500 cells/µL suggests reduced capacity to defend a new implant.
• Iron: correcting anaemia helps ensure enough oxygen reaches healing tissue — after establishing why the anaemia is there, since in a man of this age group it can itself be the first sign of something that needs investigating.

2. Intraoperative Vigilance: Protecting the Sterile Field

The operating theatre is a controlled environment, but not a perfect one. Orthopaedics has developed near-theatrical levels of precision to maintain sterility — standards urology is actively adopting.

Skin Preparation and Hand Hygiene

• Clippers, not razors: razors create microscopic cuts that become breeding grounds for bacteria. Surgical clippers are used immediately before the procedure.
• Better antisepsis: a combination of chlorhexidine and alcohol has proven more effective than iodine alone.
• Double gloving: two pairs of gloves provide a backup barrier, with the outer pair changed at the moment the implant is handled — the most critical sterility window.

Managing the Environment

• Traffic control: every time a theatre door opens, air currents carry skin scales and bacteria into the room. Minimising traffic and keeping non-essential personnel at least a metre away from sterile instruments is a key orthopaedic principle.
• Suction and lights: sterile light handles shed debris if moved frequently, and suction tips accumulate airborne particles. Orthopaedic teams often replace suction tips hourly and set lights before the patient is draped.
• Gown-glove sealing: the gap between gown and glove is a known weak point, and occlusive strips close it.

3. Postoperative Care: The Critical Recovery Window

Once the operation is finished the job is not. The first weeks are the most vulnerable time for a new prosthesis.

• Dry and clean: the most basic advice is often the best.
• Drains cut both ways: a drain removes fluid that would otherwise collect, but it is also a route inward. The trend, following orthopaedics, is to avoid drains where possible or remove them early — balanced against the bleeding risk in a man on anticoagulation, where a drain may be the safer choice.

Long-Term Health and Hygiene

An infection can occur months or even years later if bacteria from elsewhere in the body enter the bloodstream. Good general and dental health is therefore part of protecting any internal prosthesis. Note, though, that this does non mean routinely taking antibiotics before dental treatment: that practice has fallen out of favour for prosthetic implants generally, and it is a question for your urologist rather than an assumption. What is worth doing is telling your dentist that you have an implant.

What Any of This Asks of You

Stripped of the thresholds, the patient’s side of this list is short:

• Get blood glucose as well controlled as it can be in the weeks before surgery, working with whoever manages your diabetes.
• Stop smoking, as far ahead as you can manage. Six weeks is the figure orthopaedic surgeons use; more is better and some is better than none.
• Report any infection anywhere in the body before the operation — a urine infection, a skin infection, a dental abscess, something that seems unrelated. It may be worth postponing for.
• Follow the washing and medication instructions your hospital gives you, rather than a protocol found online.
• Afterwards, keep the wound clean and dry, and know the warning signs.

Those warning signs, briefly: fever or chills, spreading redness or discharge, pain that increases after the first few days instead of settling, a tense or rapidly swelling scrotum, inability to pass urine, or any part of the device becoming visible — all of which need to be reported the same day rather than at the next appointment. And an implant infection can also appear months later as pain that never quite settles. Reporting early is often what decides whether the device can be saved. The longer history of how implant infection was brought under control covers this in more detail.

La linea di fondo

The path to better outcomes in urology is often paved with the successes of other surgical fields. By viewing the penile prosthesis through the lens of orthopaedic arthroplasty, we move toward a standard of care where infection is uncommon. Uncommon, not impossible — the risk remains higher in men with diabetes, in men who are immunosuppressed, and in revision surgery, and no protocol removes it entirely.

For men exploring a penile prosthesis as a treatment for disfunzione erettile, choosing a surgeon who follows rigorous infection-prevention protocols is one of the more consequential decisions available to you — alongside understanding that the operation itself is irreversible. These protocols are applied as standard rather than as optional extras; see how they fit into the wider penile prosthesis surgery service, from device selection through to long-term follow-up.

If you are considering penile prosthesis surgery and would like a full evaluation, Dr. Soarawee Weerasopone consults at Ospedale Bangokok Sede Centrale and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. It suits an initial discussion and planning the preparation described above; assessment and surgery require an in-person visit. Samitivej Sriracha is in-person only.

Frequently Asked Questions About Penile Prosthesis Infection

How common is infection after penile prosthesis surgery?

Uncommon in experienced hands, thanks to antibiotic-coated devices, chlorhexidine-alcohol skin preparation and refined technique. It has not been eliminated, and the risk is higher in men with diabetes, in men who are immunosuppressed, and in revision surgery. A single infection matters disproportionately because it usually means removing the device and replacing it at a second operation.

Why is diabetes such a significant risk factor?

High blood sugar impairs white blood cell function, weakens the immune response and slows wound healing. Achieving an HbA1c below 7% before surgery and keeping postoperative glucose below 180 mg/dL reduces that risk, and is worth the weeks it takes to arrange.

How long should I stop smoking before penile prosthesis surgery?

Following orthopaedic practice, at least six weeks before surgery. Nicotine constricts blood vessels and reduces oxygen delivery to healing tissue, increasing the risk of wound complications and device infection. If six weeks is not possible, stopping for any period beforehand is still better than not stopping.

Should I buy antiseptic wash or nasal ointment before my operation?

No — ask your surgical team what their protocol is instead. Mupirocin is a prescription antibiotic and using it without indication contributes to resistance, and antiseptic washes have specific instructions and timing. Assembling a protocol from an article is not the same as following the one your hospital uses.

Can dental problems cause a penile prosthesis infection?

Bacteria from a significant dental infection can enter the bloodstream and, in principle, settle on any prosthetic device. Good oral health is therefore worth maintaining, and your dentist should know you have an implant. This is not the same as routinely taking antibiotics before dental treatment, which is no longer standard practice for prosthetic implants — ask your urologist rather than assuming either way.

What should I watch for after the operation?

Fever or chills, spreading redness or discharge, pain increasing after the first few days rather than settling, a tense or rapidly swelling scrotum, inability to pass urine, or any part of the device becoming visible. Report these the same day. An implant infection can also appear months later as pain that never quite settles.

Disclosure: Dr. Soarawee Weerasopone has received travel and accommodation support from Boston Scientific for prosthetic surgery training workshops. He receives no payment from any manufacturer for this article, and device selection for patients is based on clinical factors.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Thresholds and protocols described here are for clinical reference and should not be self-applied. No advice, diagnosis or prescription is given through personal messaging channels or social media. Always consult a qualified healthcare professional before starting or changing any medical treatment.