Prolonged survival and risk factors for reintervention after inflatable penile prosthesis implantation

Inflatable Penile Prosthesis (IPP) is the treatment for erectile dysfunction (ED) refractory to pharmacological therapies. Long-term data on factors associated with prosthesis survival remain unclear. This study aimed to analyze the long-term survival of penile prostheses and identify risk factors associated with survival without reintervention.

This is a retrospective, single-center study of patients who underwent IPP implantation between January 2014 and December 2022. Preoperative data related to the patient and the etiology of ED, as well as perioperative data, were collected. The primary outcome was survival without reintervention, defined as prosthesis revision or explantation due to mechanical dysfunction or infection. We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model.

In total, 33 out of 137 patients underwent reintervention (24.1%), including 24 (17.5%) prosthesis revisions and 9 (6.6%) had explantations. Median follow-up was 39 months with an interquartile range (IQR) of 9.00 to 62.00. Median survival without reintervention was 7 years. In univariate analysis, downsizing (p = 0.046) was associated with reintervention. Smoking (p = 0.003) and age (p = 0.034) were associated with prosthesis explantation. The number of implantations (p = 0.009) was associated with prosthesis revision. Multivariate analysis by the Cox model did not identify any independent predictive factors for reintervention.

Smoking may play a role in infection post-IPP implantation. Primary implantations seem to be associated with better survival. Adjusting cylinder size, known as downsizing, is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention.