Infection rates and risk factors following inflatable penile prosthetic implantation: an analysis of real-world hospital data.

BACKGROUND

Erectile dysfunction significantly affects quality of life, and while inflatable penile prosthesis (IPP) is a definitive treatment option, post-operative infections remain a concern, requiring better understanding of patient-level risk factors.

AIM: This study sought to analyze infection rates following IPP and to identify risk factors associated with infection using real-world data.

METHODS

Retrospective analysis was performed among patients aged ≥18 who underwent IPP insertion between 2016 and 2022 in the U.S using the Premier PINC AI™ Healthcare Database. Cox proportional hazards regression was used for statistical analysis.

OUTCOMES: The primary outcome was infection rate post-IPP over time; twelve known risk factors examined included: older age (≥75), smoking status, positive human immunodeficiency virus status, diabetes (Type 1 and 2, with and without comorbidities), history of pelvic radiation, history of urinary diversion, spinal cord injury, obesity, concomitant circumcision, and Peyronie's disease.

RESULTS

Among 18 475 males with IPP surgery, the overall infection rate post-IPP was 3.1% at a median follow-up of 3 years, with 2.5% occurring within the first 6 months. The infection rate at 3 years was significantly higher for patients with at least one risk factor compared to those without any (3.9% vs. 2.8%, HR 1.40 [95% CI 1.14, 1.72]). Patients with ≥3 risk factors had the highest infection rate (5.6% vs. 2.8%, HR 2.18 [95% CI 1.26, 3.75]). Among 12 risk factors analyzed, five were significantly and positively associated with infection rate: Type 2 diabetes with comorbidities (4.7% vs. 3.0%, HR 1.56 [95% CI: 1.14, 2.1.3]), Type 2 diabetes without comorbidities (4.3% vs. 3.0%, HR 1.38 [95% CI: 1.06, 1.79]), spinal cord injury (9.8% vs. 3.0%, HR 2.81 [95% CI: 1.33, 5.93]), obesity (5.2% vs. 3.0%, HR 1.74 [95% CI: 1.26, 2.41]), and concomitant circumcision (6.6% vs. 3.0%, HR 2.01 [95% CI: 1.04, 3.89]).

CLINICAL IMPLICATIONS: The overall rate of infection post-IPP was low, with most infections occurring within the first 6 months, particularly among higher risk patients, highlighting the importance of close early postoperative monitoring.

STRENGTHS & LIMITATIONS: Strengths include the large patient population and data from diverse clinical settings. However, hospital claims data may lack granularity and may have coding errors/misclassifications.

CONCLUSION

This large observational study confirmed the low rate of infection post-IPP overall and that certain risk factors such as Type 2 diabetes, spinal cord injury, obesity, and concomitant circumcision significantly increased its likelihood, suggesting that optimizing specific risk factors preoperatively could enhance outcomes and improve patient care.