What are we missing with fungal infection? - preventive role of surgical hoods in inflatable penile prosthesis surgery: a case report and literature review.

Fungal infections after inflatable penile prosthesis (IPP) surgery are uncommon but clinically significant due to their association with prosthesis loss and reoperation. While antifungal prophylaxis has been proposed as a preventive strategy, supporting evidence remains limited and inconsistent. At our institution, perioperative antifungal agents have never been part of the IPP protocol. Among 1772 cases performed without antifungal use, we encountered a single fungal infection caused by Meyerozyma guilliermondii, which matched the operating surgeon's otitis externa isolate. Following this event, we implemented routine use of surgical hoods that fully cover the ears and scalp for all scrubbed personnel. Since then, over 1535 IPP procedures have been performed without a single fungal infection. Based on this experience and a review of relevant literature, we propose that surgical hoods that fully cover the ears and scalp may offer a simple, cost-effective, and underutilized means of reducing fungal contamination during urologic prosthetic surgery.