Risky business: penile prosthesis in high-risk patients

Patients with diabetes and other immunocompromising conditions may be at higher risk for penile prosthesis complications. However, data on this patient population is limited and at times contradictory. We review our operative and post-operative experience with inflatable penile prosthesis placement in these high-risk patients at a major urban tertiary-care center. We hypothesize that peri-operative hyperglycemia may increase the likelihood of postoperative complications and that a peri-operative glycosylated hemoglobin (HbA1c) greater than 8.5 may be associated with higher rates of device infection, erosion, and malfunction.

We retrospectively reviewed patients undergoing penile prosthesis insertion at a single institution from 2012-2023. We recorded peri-operative HbA1c in addition to mean and maximum peri-operative blood glucose levels. The primary outcome was device infection leading to reoperation. Secondary outcomes included device erosion or device component malfunction.

Two hundred and thirty-five cases among 200 patients met inclusion criteria. 179 were first-time implants with 56 revision surgeries. Of the 235 surgeries, patients with diabetes underwent 107 surgeries, those with human immunodeficiency virus (HIV) underwent 6, solid organ transplant history underwent 10, and end-stage renal disease (ESRD) underwent 12. The mean patient age was 61.8 years. Perioperative HbA1c was higher among diabetics (7.7 vs. 5.9 g/dL, P<0.001) as was mean blood glucose (167.5 vs. 113.2 mg/dL, P<0.001 and max blood glucose 197.2 vs. 123.3 mg/dL, P<0.001). Infections requiring reoperation occurred in 2.8% of diabetics and 3.4% of non-diabetics (P=0.79). No difference was seen in device reoperation rates at either a HbA1c cut-off of 8.5 or 10 g/dL.

Device-related complications were not more common among diabetic patients compared to non-diabetic counterparts. No differences in rates of device infection, device malfunction, or device erosion were noted in our findings. Furthermore, a preoperative HbA1c cutoff of 8.5 and 10 g/dL was not associated with an increased rate of prosthetic complications.