Does Lowering Hemoglobin A1c Reduce Penile Prosthesis Infection: A Systematic Review

Area of Science:

• Urology
• Endocrinology
• Infectious Disease

Background:

• Hemoglobin A1c (HbA1c) measures long-term blood glucose control.
• Elevated HbA1c is sometimes used to predict infection risk after prosthetic surgery.
• Surgeons may require patients to lower HbA1c before penile prosthesis (PP) implantation.

Purpose of the Study:

• To comprehensively review the existing literature on the relationship between HbA1c levels and penile prosthesis (PP) infection.
• To evaluate HbA1c as a potential predictor of PP infection.
• To assess the evidence for lowering HbA1c to reduce PP infection rates.

Main Methods:

• A systematic literature search was conducted using PubMed.
• English-language articles investigating the link between HbA1c and PP infection were included.
• Studies were selected if they reported mean HbA1c and compared infection rates between patients with and without prosthetic infection.

Main Results:

• Six studies published between 1992 and 2020 were identified.
• Two of four recent studies (post-2000) showed a significant difference in mean HbA1c between infected and non-infected PP patients (9.1% vs 7.5% and 9.5% vs 7.8%).
• The other two recent studies found no significant difference in mean HbA1c (7.0% vs 7.6% and 7.6% vs 7.5%).

Conclusions:

• Current evidence is inconclusive regarding HbA1c's role in predicting penile prosthesis infection.
• While HbA1c is increasingly used as a preoperative risk factor, consensus is lacking.
• Larger randomized controlled trials are necessary to determine if actively lowering perioperative HbA1c reduces prosthetic infection risk.