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Does Lowering Hemoglobin A1c Reduce Penile Prosthesis Infection: A Systematic Review
Brian P Dick1, Ayad Yousif1, Omer Raheem1
1Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Insights
This review found that current data on Hemoglobin A1c (HbA1c) as a predictor of penile prosthesis infection are inconclusive. Further research is needed to confirm if lowering HbA1c reduces infection risk.
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.
Introduction:
Hemoglobin A1c (HbA1c), a glycated form of hemoglobin, develops when glucose is elevated in the blood. It is used as a marker of how well a diabetic patient has been controlling their blood sugar over the previous 3-4 months. Some use HbA1c as a predictor of infection risk during prosthetic surgery, and many surgeons require patients to lower it preoperatively.
Objective:
This study was designed to comprehensively review the literature relating HbA1c and penile prosthesis (PP).
Methods:
A PubMed search of English-language articles identified studies that investigate the relationship between HbA1c levels and PP infection. Studies were only included if they reported the mean HbA1c of all PP patients and compared patients who did/did not develop a prosthetic infection. References from relevant articles are included.
Results:
A total of 6 studies, 1992-2020, were identified. 2 studies occurred before the advent of antibiotic-enhanced devices in the early 2000s and have limited applicability to the modern era. Of the 4 studies published after, 2 reported a significant difference in mean HbA1c when comparing patients who developed a prosthetic infection and those who did not (9.1% vs 7.5%, P = .000 and 9.5% vs 7.8%, P < .001). The other 2 studies reported no significant difference in mean HbA1c when comparing patients who developed a prosthetic infection and those who did not (7.0% vs 7.6%, P > .05; and 7.6% vs 7.5%, P = .598).
Conclusion:
Current data regarding HbA1c as a predictor of PP infection are inconclusive, with no consensus. HbA1c is increasingly used as a predictor of postsurgical prosthetic infection, with some urologists requiring patients with elevated HbA1c to acutely lower it before elective surgery. While there are a number of established health benefits of controlling elevated blood sugar, larger randomized controlled trials need to validate whether acutely lowering perioperative HbA1c decreases risk of prosthetic infection. Dick BP, Yousif A, Raheem O, et al. Does Lowering Hemoglobin A1c Reduce Penile Prosthesis Infection: A Systematic Review. Sex Med Rev 2021;9:628-635.
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