Session: PD42: Sexual Function/Dysfunction: Surgical Therapy II
PD42-09: Intracavernosal Injection History is Associated with Increased Intra- and Postoperative Inflatable Penile Prosthesis Complications: A Multi-institutional Analysis.
Introduction: Intracavernosal injection (ICI) is a standard treatment for men with refractory erectile dysfunction (ED). ICI can create corporal scarring which could make insertion of inflatable penile prosthesis (IPP) more difficult. Associations between ICI use and complications from IPP surgery were assessed using a large multi-institutional database. Methods: All primary and revision IPP cases from 2016-2021 were included from an international retrospective database of IPP surgeries of 16 expert implanters at 16 institutions. Patients with indeterminate history of ICI or covariates were excluded. Covariates investigated included age, BMI, diabetes, hypertension, vasculopathy, smoking, history of pelvic radiation and/or radical prostatectomy. Outcomes included intraoperative complications (perforation, crossover, urethral injury), postoperative non-infectious complications (healing, device malfunction, etc.) and postoperative infection. Patients were stratified by history of ICI and between-group differences in risk factors were assessed with serial t-test or Fisher’s test as appropriate. Multivariate logistic regression was used to assess for predictors of intraoperative complications, postoperative non-infectious complications and postoperative infection. Results: A total of 3110 patients met inclusion criteria of which 914 (29.4%) had a history of ICI. On average, patients with a history of ICI tended to be older (62 vs 63) and were more likely to have vasculopathy, as well as prior radical prostatectomy and/or radiation. On regression, a history of ICI, smoking and radiation were all significant predictors of intraoperative complications (OR 2.08, p=0.007, OR 2.02. p=0.014, OR 2.27, p=0.035 respectively). A history of ICI and patient age were both significant predictors of non-infectious postoperative complications (OR 1.37, p=0.018, OR 1.02, p=0.017 respectively). None of the variables were significant predictors of infection. Conclusions: This investigation supports the hypothesis that a history of ICI may increase the risks of IPP surgery. Patients with ICI history experienced intraoperative complications at over twice the expected rate, similar to smokers and patients with a history of pelvic radiation. This is the largest study to date investigating the relationship between ICI and complications with IPP placement. These results may aid Urologists and patients in approaching treatment for ED. SOURCE OF Funding: None
