Comparative effects of hypochlorous acid and povidone-iodine on infection and allergy risks in penile prosthesis surgery

Background: Penile prosthesis implantation carries an unavoidable risk of infection, which can lead to severe morbidity. This study aims to evaluate the efficacy of hypochlorous acid (HOCl) compared to povidone-iodine (PI) for surgical site antisepsis, with particular emphasis on infection prevention and allergic reaction rates. Methods: A retrospective analysis was conducted on 159 patients who underwent penile prosthesis implantation by a single surgeon. Patients were categorized into two groups: the PI group (n = 80, surgeries performed before 2023) and the HOCl group (n = 79, surgeries performed in 2023 and 2024). Postoperative infection rates and allergic reactions were recorded and statistically analyzed. Results: The number of infection and allergic reaction events was lower in the HOCl group (n = 4 and n = 1, respectively) compared to the PI group (n = 5 and n = 4, respectively), although the differences were not statistically significant. No cases required revision surgery due to infection and related interventions. HOCl demonstrated antimicrobial efficacy comparable to PI, while offering a substantial reduction in allergic reactions. Conclusions: HOCl appears to be an effective and well-tolerated antiseptic alternative to PI in penile prosthesis surgery. As the first study to investigate HOCl in this context, these findings provide a foundation for future research and clinical applications.