Laminar Airflow in Penile Prosthesis Surgery and Infection: An Empty Systematic Review

TL;DR

This review found no studies on whether laminar airflow reduces infection risk in penile prosthesis surgery, suggesting other infection prevention methods should be prioritized.

Contribution

The paper highlights the lack of direct evidence for laminar airflow's effectiveness in penile prosthesis surgery and recommends alternative infection prevention strategies.

Findings

No eligible studies were found comparing laminar airflow to conventional ventilation in penile prosthesis surgery.

Indirect evidence from other surgeries suggests laminar airflow may not consistently reduce infections in real-world settings.

Multimodal infection prevention bundles are recommended until more data is available.

Abstract

Penile prosthesis (PP) infection is uncommon but serious. Laminar airflow/ultraclean ventilation (LAF/UCV) aims to reduce airborne bioburden, but its clinical impact on PP infection is unclear. We registered a protocol in PROSPERO (CRD420251128507) and followed PRISMA 2020/PRISMA-S, searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL, CINAHL, and Dimensions (no date limits), screening reference lists/forward citations, and reviewing professional guidance. Eligible studies were randomised or non-randomised comparative PP studies reporting infection by LAF/UCV versus conventional ventilation; portable high-efficiency particulate air (HEPA)/UV recirculators were excluded a priori. Two reviewers independently screened the results; meta-analysis was prespecified if appropriate, otherwise a narrative synthesis was used. Of 99 records (98 databases; 1 other), 26 duplicates were removed; 72 titles/abstracts were screened; 2 full texts were assessed. As a result, no study met the inclusion criteria, and no meta-analysis was possible. Indirect evidence from orthopaedic, breast, vascular, and cardiac surgery shows no consistent reduction in deep surgical-site infection with LAF compared with conventional ventilation under real-world conditions where unidirectionality can be disrupted by door openings, staff/equipment movement, and thermal plumes. Evidence from other specialties is indirect and of uncertain applicability to penile prosthesis surgery. No eligible comparative penile prosthesis studies evaluating LAF/UCV versus conventional ventilation were identified; this is therefore an empty systematic review. Pending procedure-specific data, practice should prioritise multimodal infection-prevention bundles (e.g., antibiotic prophylaxis, "no-touch" technique, traffic control) and verification of ventilation performance during live use; future multicentre observational studies or cluster/stepped-wedge trials should prospectively capture ventilation parameters and key confounders to enable robust comparisons and cost-effectiveness analyses.

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