Successful Complex Penile Prosthesis Implant in Patients with High Risk of Fecal Contamination: A Case Report

Successful Complex Penile Prosthesis Implant in Patients with High Risk of Fecal Contamination: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Successful Complex Penile Prosthesis Implant in Patients with High Risk of Fecal Contamination: A Case Report Vineet Malhotra, Anil Kumar Sah, TK Aravind This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7884332/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Apr, 2026 Read the published version in BMC Urology → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Penile prosthesis implantation in patients at risk of fecal contamination poses significant surgical challenges due to the heightened possibility of postoperative infection. Case presentation: We report two cases of young male patients with refractory erectile dysfunction following multimodal treatment for carcinoma anorectum. The first patient had undergone abdominoperineal resection with colostomy in situ, while the second had a low anterior resection with subsequent reversal but developed persistent fecal incontinence. Both patients had normal hormonal profiles and had failed conservative management with oral and injectable agents. Malleable penile prosthesis implantation was performed under general anesthesia using rigorous aseptic protocols, including extended skin preparation, isolation of contaminated sites with specialized draping, and repeated intraoperative irrigation with broad-spectrum antibiotic solutions. Both procedures were uneventful, and postoperative follow-up demonstrated satisfactory healing and prosthesis function without infection. Conclusions: With meticulous preparation, field isolation, and surgical discipline, penile prosthesis implantation can be successfully achieved even in patients with a high risk of fecal contamination. Aseptic technique Complex penile implant Infection-free Malleable penile prosthesis Case report Figures Figure 1 Figure 2 Introduction Erectile dysfunction (ED) is a well-recognized complication following major pelvic oncological surgery, often exacerbated by adjuvant radiotherapy or chemotherapy. When conservative therapies fail, penile prosthesis implantation remains a definitive treatment option. However, patients with colostomy or fecal incontinence pose unique surgical challenges due to the increased risk of contamination and subsequent prosthesis infection. We present two cases of malleable penile prosthesis implantation performed under strict aseptic measures in patients with a history of carcinoma anorectum and potential fecal contamination risk. Case Presentation Case 1 A 26-year-old male presented with refractory ED following abdominoperineal resection (APR) and colostomy in situ for adenocarcinoma of the anorectum, performed five years earlier. He had received adjuvant radiotherapy and failed both oral and injectable therapy. The patient had no other comorbidities. After preoperative evaluation, a malleable penile prosthesis (SHAH WH 13 implant) was inserted under general anesthesia. Case 2 A 42-year-old male presented with refractory ED following low anterior resection (LAR) with adjuvant chemoradiotherapy for carcinoma anorectum three years earlier. Although colostomy had been reversed, he developed persistent fecal incontinence. He was also a known case of hypothyroidism under regular medication for six years. He underwent malleable penile prosthesis implantation (Promedon T-130 VS) under general anesthesia. Surgical Protocol and Infection Control In both cases, a series of precautions were undertaken to maintain maximal intraoperative sterility and reduce contamination. Preoperative preparation included extended priming with 7.5% povidone-iodine scrub solution for 10 minutes. [Figure 1 ] The colostomy site was separately cleaned and sealed with occlusive sterile draping. A small window was created to expose only the penis and scrotum, and a double-draping technique was applied. [Figure 2 ] Frequent glove changes, repeated irrigation with antibiotic solution (gentamicin 800 mg + vancomycin 1 g in 1 L saline), and avoidance of unnecessary instrument exchanges were followed. Perioperative intravenous cefepime and amikacin were administered for 48 hours, followed by oral cefuroxime and clarithromycin for one week. Both procedures were uneventful. In the second case, a suprapubic catheter was inserted preoperatively and removed on the fifth postoperative day. Wound inspection revealed satisfactory healing without signs of infection or erosion in either case. Discussion Penile prosthesis implantation remains the definitive therapy for men with medication-refractory erectile dysfunction, providing durable functional and psychological benefits. [3] Despite its high success rates, infection continues to be one of the most dreaded complications, historically reported in 1–8% of cases, with risk influenced by patient comorbidities, surgical environment, and device type. Infection in penile implant surgery is particularly devastating, as it often mandates device removal, delayed reimplantation, and prolonged antibiotic therapy, resulting in substantial morbidity and patient dissatisfaction.[4] Multiple factors predispose to prosthesis infection, including diabetes mellitus, spinal cord injury, immunosuppression, revision surgery, and prior pelvic operations. Among these, fecal contamination represents an uncommon but particularly serious risk.[3] Patients with colostomy, fecal incontinence, or impaired perineal hygiene face a markedly elevated risk of prosthesis colonization by enteric flora, given the proximity of the surgical site to the perineum. Such scenarios demand exceptional attention to infection prevention, both in surgical planning and execution.[2] Over recent decades, advances in surgical technique and implant technology have reduced infection rates substantially.[5] The development of antibiotic-coated or hydrophilic-coated devices has been particularly impactful, as these implants can be impregnated with antimicrobial solutions intraoperatively, reducing bacterial adherence and biofilm formation.[6] In addition, perioperative systemic antibiotics targeting both skin and enteric organisms are recommended as standard practice. Strict adherence to aseptic technique is critical, with strategies such as the “no-touch technique,” meticulous draping, and careful field isolation playing a central role in infection prevention.[5] The present cases involved young men with refractory erectile dysfunction following radical surgery and adjuvant treatment for anorectal carcinoma. Their complex pelvic anatomy, fibrotic tissues, and the presence of colostomy or fecal incontinence created an inherently high-risk environment for implant infection.[6] To counter these risks, comprehensive preoperative, intraoperative, and postoperative measures were implemented. Preoperatively, bowel care, stoma optimization, and meticulous perineal cleansing were emphasized. Intraoperative strategies included extended skin preparation, isolation of the stoma with plastic draping and padding, double draping systems, and restricted operative windows to limit exposure. Frequent glove changes, repeated irrigation with antibiotic solutions, limited operative time, and suprapubic catheterization in select cases further minimized contamination. Postoperatively, careful tissue handling, precise hemostasis, elimination of dead space, appropriate prosthesis sizing, and patient education on hygiene and wound care were integral to success. These measures allowed successful implantation without infection, even in a setting where fecal contamination risk was high. The experience underscores that meticulous surgical planning, adherence to preventive protocols, and patient engagement can together overcome one of the most challenging scenarios in prosthetic urology.[5,6] Penile prosthesis implantation can be safely performed in patients with a high risk of fecal contamination, provided meticulous aseptic precautions and careful intraoperative planning are undertaken. These cases highlight that successful outcomes with malleable penile prosthesis are achievable even in complex clinical scenarios, offering definitive management of refractory erectile dysfunction. Conclusion Penile prosthesis implantation can be safely and effectively performed in patients with a high risk of fecal contamination through meticulous adherence to aseptic principles, strategic field isolation, and antibiotic prophylaxis. Abbreviations ED Erectile dysfunction APR Abdominoperineal resection LAR Low anterior resection SHAH WH SHAH With Hinge Declarations Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from both patients for publication of this case report and accompanying images. Funding: None. Authors’ contributions: Both authors performed the surgeries and conceptualized the study. They equally contributed in data collection, literature review, and manuscript preparation. Both authors approved the final manuscript. Author Contribution Authors’ contributions: Both authors performed the surgeries and conceptualized the study. They equally contributed in data collection, literature review, and manuscript preparation. Both authors approved the final manuscript. Data Availability Not applicable. References Alkassis M, Lee A, Iwuala R, Kocjancic E. Penile implant infection: Risk factors, prevention, and management. Int J Reconstr Urol. 2024;2(2):114–23. Menshchikov K, Menshchikov M, Yurasov D, Artamonov A. Risk factors for penile prosthesis infection: An umbrella review and meta-analysis. Arab J Urol. 2024;22(2):96–101. Ziegelmann MJ. Penile prosthesis infection—moving the needle forward. Int J Impot Res. 2020;32(6):635–7. Adams ES, Tua-Caraccia RD, Lentz AC. Narrative review of immediate salvage for penile prosthesis infection. Transl Androl Urol. 2024;13(4):584–95. Carrasquillo RJ, Munarriz RM, Gross MS. Infection prevention considerations for complex penile prosthesis recipients. Curr Urol Rep. 2019;20(3):1–7. Van Huele A, Van Renterghem K. Penile prosthesis in the medically complex patient: A narrative review. Transl Androl Urol. 2023;12:1885–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Apr, 2026 Read the published version in BMC Urology → Version 1 posted Editorial decision: Revision requested 31 Dec, 2025 Reviews received at journal 29 Dec, 2025 Reviews received at journal 21 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviewers agreed at journal 07 Dec, 2025 Reviewers invited by journal 11 Nov, 2025 Editor invited by journal 10 Nov, 2025 Editor assigned by journal 07 Nov, 2025 Submission checks completed at journal 07 Nov, 2025 First submitted to journal 17 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":727210,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative priming with 7.5% Povidone iodine solution for 10 minutes\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7884332/v1/a3ac1213be4feacade97a2d4.jpeg"},{"id":96492108,"identity":"30dc545b-0e7c-4b16-8c3e-0c3054f3dbfb","added_by":"auto","created_at":"2025-11-21 18:05:41","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":496359,"visible":true,"origin":"","legend":"\u003cp\u003eDouble draping system\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7884332/v1/218b234e59e689c63ac9be24.jpeg"},{"id":107351057,"identity":"b4b05871-d93c-46f9-8c1a-6d1674a2cef5","added_by":"auto","created_at":"2026-04-20 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When conservative therapies fail, penile prosthesis implantation remains a definitive treatment option. However, patients with colostomy or fecal incontinence pose unique surgical challenges due to the increased risk of contamination and subsequent prosthesis infection. We present two cases of malleable penile prosthesis implantation performed under strict aseptic measures in patients with a history of carcinoma anorectum and potential fecal contamination risk.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCase 1\u003c/h2\u003e\u003cp\u003eA 26-year-old male presented with refractory ED following abdominoperineal resection (APR) and colostomy in situ for adenocarcinoma of the anorectum, performed five years earlier. He had received adjuvant radiotherapy and failed both oral and injectable therapy. The patient had no other comorbidities. After preoperative evaluation, a malleable penile prosthesis (SHAH WH 13 implant) was inserted under general anesthesia.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCase 2\u003c/h3\u003e\n\u003cp\u003eA 42-year-old male presented with refractory ED following low anterior resection (LAR) with adjuvant chemoradiotherapy for carcinoma anorectum three years earlier. Although colostomy had been reversed, he developed persistent fecal incontinence. He was also a known case of hypothyroidism under regular medication for six years. He underwent malleable penile prosthesis implantation (Promedon T-130 VS) under general anesthesia.\u003c/p\u003e\n\u003ch3\u003eSurgical Protocol and Infection Control\u003c/h3\u003e\n\u003cp\u003eIn both cases, a series of precautions were undertaken to maintain maximal intraoperative sterility and reduce contamination.\u003c/p\u003e\u003cp\u003ePreoperative preparation included extended priming with 7.5% povidone-iodine scrub solution for 10 minutes. [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] The colostomy site was separately cleaned and sealed with occlusive sterile draping. A small window was created to expose only the penis and scrotum, and a double-draping technique was applied. [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e] Frequent glove changes, repeated irrigation with antibiotic solution (gentamicin 800 mg\u0026thinsp;+\u0026thinsp;vancomycin 1 g in 1 L saline), and avoidance of unnecessary instrument exchanges were followed. Perioperative intravenous cefepime and amikacin were administered for 48 hours, followed by oral cefuroxime and clarithromycin for one week.\u003c/p\u003e\u003cp\u003eBoth procedures were uneventful. In the second case, a suprapubic catheter was inserted preoperatively and removed on the fifth postoperative day. Wound inspection revealed satisfactory healing without signs of infection or erosion in either case.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePenile prosthesis implantation remains the definitive therapy for men with medication-refractory erectile dysfunction, providing durable functional and psychological benefits. [3] Despite its high success rates, infection continues to be one of the most dreaded complications, historically reported in 1\u0026ndash;8% of cases, with risk influenced by patient comorbidities, surgical environment, and device type. Infection in penile implant surgery is particularly devastating, as it often mandates device removal, delayed reimplantation, and prolonged antibiotic therapy, resulting in substantial morbidity and patient dissatisfaction.[4]\u003c/p\u003e\u003cp\u003eMultiple factors predispose to prosthesis infection, including diabetes mellitus, spinal cord injury, immunosuppression, revision surgery, and prior pelvic operations. Among these, fecal contamination represents an uncommon but particularly serious risk.[3] Patients with colostomy, fecal incontinence, or impaired perineal hygiene face a markedly elevated risk of prosthesis colonization by enteric flora, given the proximity of the surgical site to the perineum. Such scenarios demand exceptional attention to infection prevention, both in surgical planning and execution.[2]\u003c/p\u003e\u003cp\u003eOver recent decades, advances in surgical technique and implant technology have reduced infection rates substantially.[5] The development of antibiotic-coated or hydrophilic-coated devices has been particularly impactful, as these implants can be impregnated with antimicrobial solutions intraoperatively, reducing bacterial adherence and biofilm formation.[6] In addition, perioperative systemic antibiotics targeting both skin and enteric organisms are recommended as standard practice. Strict adherence to aseptic technique is critical, with strategies such as the \u0026ldquo;no-touch technique,\u0026rdquo; meticulous draping, and careful field isolation playing a central role in infection prevention.[5]\u003c/p\u003e\u003cp\u003eThe present cases involved young men with refractory erectile dysfunction following radical surgery and adjuvant treatment for anorectal carcinoma. Their complex pelvic anatomy, fibrotic tissues, and the presence of colostomy or fecal incontinence created an inherently high-risk environment for implant infection.[6] To counter these risks, comprehensive preoperative, intraoperative, and postoperative measures were implemented.\u003c/p\u003e\u003cp\u003ePreoperatively, bowel care, stoma optimization, and meticulous perineal cleansing were emphasized. Intraoperative strategies included extended skin preparation, isolation of the stoma with plastic draping and padding, double draping systems, and restricted operative windows to limit exposure. Frequent glove changes, repeated irrigation with antibiotic solutions, limited operative time, and suprapubic catheterization in select cases further minimized contamination. Postoperatively, careful tissue handling, precise hemostasis, elimination of dead space, appropriate prosthesis sizing, and patient education on hygiene and wound care were integral to success.\u003c/p\u003e\u003cp\u003eThese measures allowed successful implantation without infection, even in a setting where fecal contamination risk was high. The experience underscores that meticulous surgical planning, adherence to preventive protocols, and patient engagement can together overcome one of the most challenging scenarios in prosthetic urology.[5,6]\u003c/p\u003e\u003cp\u003ePenile prosthesis implantation can be safely performed in patients with a high risk of fecal contamination, provided meticulous aseptic precautions and careful intraoperative planning are undertaken. These cases highlight that successful outcomes with malleable penile prosthesis are achievable even in complex clinical scenarios, offering definitive management of refractory erectile dysfunction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePenile prosthesis implantation can be safely and effectively performed in patients with a high risk of fecal contamination through meticulous adherence to aseptic principles, strategic field isolation, and antibiotic prophylaxis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eErectile dysfunction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAPR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAbdominoperineal resection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLAR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow anterior resection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSHAH WH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSHAH With Hinge\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003e Written informed consent was obtained from both patients for publication of this case report and accompanying images.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNone.\u003c/p\u003e\u003cp\u003eAuthors\u0026rsquo; contributions: Both authors performed the surgeries and conceptualized the study. They equally contributed in data collection, literature review, and manuscript preparation. Both authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors\u0026rsquo; contributions: Both authors performed the surgeries and conceptualized the study. They equally contributed in data collection, literature review, and manuscript preparation. Both authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlkassis M, Lee A, Iwuala R, Kocjancic E. Penile implant infection: Risk factors, prevention, and management. Int J Reconstr Urol. 2024;2(2):114\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenshchikov K, Menshchikov M, Yurasov D, Artamonov A. Risk factors for penile prosthesis infection: An umbrella review and meta-analysis. Arab J Urol. 2024;22(2):96\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZiegelmann MJ. Penile prosthesis infection\u0026mdash;moving the needle forward. Int J Impot Res. 2020;32(6):635\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdams ES, Tua-Caraccia RD, Lentz AC. Narrative review of immediate salvage for penile prosthesis infection. Transl Androl Urol. 2024;13(4):584\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarrasquillo RJ, Munarriz RM, Gross MS. Infection prevention considerations for complex penile prosthesis recipients. Curr Urol Rep. 2019;20(3):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Huele A, Van Renterghem K. Penile prosthesis in the medically complex patient: A narrative review. Transl Androl Urol. 2023;12:1885\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aseptic technique, Complex penile implant, Infection-free, Malleable penile prosthesis, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7884332/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7884332/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003cbr\u003e\nPenile prosthesis implantation in patients at risk of fecal contamination poses significant surgical challenges due to the heightened possibility of postoperative infection.\u003cbr\u003e\nCase presentation:\u003cbr\u003e\nWe report two cases of young male patients with refractory erectile dysfunction following multimodal treatment for carcinoma anorectum. The first patient had undergone abdominoperineal resection with colostomy in situ, while the second had a low anterior resection with subsequent reversal but developed persistent fecal incontinence. Both patients had normal hormonal profiles and had failed conservative management with oral and injectable agents. Malleable penile prosthesis implantation was performed under general anesthesia using rigorous aseptic protocols, including extended skin preparation, isolation of contaminated sites with specialized draping, and repeated intraoperative irrigation with broad-spectrum antibiotic solutions. Both procedures were uneventful, and postoperative follow-up demonstrated satisfactory healing and prosthesis function without infection.\u003cbr\u003e\nConclusions:\u003cbr\u003e\nWith meticulous preparation, field isolation, and surgical discipline, penile prosthesis implantation can be successfully achieved even in patients with a high risk of fecal contamination.\u003c/p\u003e","manuscriptTitle":"Successful Complex Penile Prosthesis Implant in Patients with High Risk of Fecal Contamination: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 18:05:36","doi":"10.21203/rs.3.rs-7884332/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-31T05:12:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T10:15:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T07:27:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172988292584977129154740961987872113468","date":"2025-12-08T18:01:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198153774195157181467531128153359356209","date":"2025-12-07T19:31:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T08:19:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-10T21:42:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-07T07:07:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-07T07:07:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-10-17T08:15:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bd630f3-d954-4cdc-a516-8caf974d1caf","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:06:29+00:00","versionOfRecord":{"articleIdentity":"rs-7884332","link":"https://doi.org/10.1186/s12894-026-02140-2","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2026-04-13 15:57:43","publishedOnDateReadable":"April 13th, 2026"},"versionCreatedAt":"2025-11-21 18:05:36","video":"","vorDoi":"10.1186/s12894-026-02140-2","vorDoiUrl":"https://doi.org/10.1186/s12894-026-02140-2","workflowStages":[]},"version":"v1","identity":"rs-7884332","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7884332","identity":"rs-7884332","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}