How to cite: Loh-Doyle JC. Updates in prosthetic urology: controversies and developments. Grand Rounds in Urology. October 2025. Accessed January 2026. https://grandroundsinurology.com/updates-in-prosthetic-urology-controversies-and-developments/
Summary
This presentation reviews evolving controversies and recent developments in prosthetic urology, with a primary focus on infection prevention strategies, emerging irrigation solutions, and new penile prosthesis pump designs. Jeffrey C. Loh-Doyle, MD, Assistant Professor of Clinical Urology, University of Southern California, Los Angeles, California, frames these advances within the broader context of cost, safety, and real-world clinical utility.
The discussion begins with a historical overview of antibiotic irrigation in prosthetic surgery, emphasizing the widespread use of vancomycin and gentamicin combinations. Data from large multi-institutional cohorts demonstrate that this combination remains the most commonly used and is associated with the lowest infection rates, particularly in hydrophilic-coated devices. Dr. Loh-Doyle challenges the perception that penile prosthesis infection rates are consistently low, highlighting higher real-world rates than traditionally reported.
Rationale for exploring alternatives to antibiotic irrigation is examined, including concerns regarding antibiotic resistance, off-label use, cost, and pharmacy delays. Antiseptic irrigations such as povidone iodine are reviewed, with evidence showing higher infection rates and concerns regarding tissue toxicity.
New irrigation strategies are discussed in detail, particularly chlorhexidine gluconate. Early randomized non-inferiority data suggest similar short-term infection outcomes compared with antibiotic irrigation. However, subsequent laboratory and clinical studies raise concerns regarding disruption of hydrophilic coatings and increased infection risk when chlorhexidine is used with these devices. Conflicting data from manufacturer-sponsored and independent studies are presented, underscoring unresolved safety questions.
Alternative non-antibiotic irrigants designed to disrupt biofilm formation are introduced, with promising orthopedic data demonstrating significant reductions in planktonic bacteria and biofilm burden with minimal cytotoxicity. Although urologic data are limited, these agents represent a potential future direction in prosthetic infection prevention.
Dr. Loh-Doyle with discussion of newly released penile prosthesis pumps, highlighting design changes intended to improve usability and durability. Early experience reveals unresolved concerns related to stiffness, altered tactile feedback, pressure-relief mechanisms, and increased cost, with no peer-reviewed evidence yet demonstrating superiority over existing designs.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Jeffrey Loh-Doyle, MD, is an assistant professor of clinical urology at the Keck School of Medicine at the University of Southern California (USC). He is a specialist in complex surgical reconstruction of the male urinary tract, male urinary incontinence, erectile dysfunction, sexual health, urethral stricture disease, and Peyronie’s disease. He joined the USC Institute of Urology after completing his medical degree, urology residency, and a fellowship training in male genitourinary reconstructive and prosthetic surgery at the Keck School of Medicine at USC.
Dr. Loh-Doyle’s areas of clinical and research interest include erectile dysfunction, male urinary incontinence, Peyronie’s disease, reconstruction of the urinary tract, and urologic oncology. In addition to urology, he also has a keen interest in health policy and quality improvement and participated in a two-year health care administration scholars program run by the Los Angeles County Department of Health. He was awarded a grant to improve the perioperative patient experience and is an active participant in several committees aimed at improving the delivery of sophisticated healthcare to the underserved.
