Login to Access Video or Poster Abstract: MP25-12
Sources of Funding: None

Introduction

Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile prosthesis (IPP) infection, the link between DM diagnosis and IPP infection remains controversial. High quality population-based data linking DM to an increased risk of IPP infection have not been published. We sought to evaluate the association of DM with IPP infection in a large public New York State database.

Methods

The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for men who underwent initial IPP insertion from 1995 to 2014. Diabetic patients were identified using ICD-9-CM codes. Patients presenting for first operation with diagnosis or CPT codes suggestive of prior IPP surgery were excluded. Chi-squared analyses were performed to compare infection rates in diabetics and non-diabetics within the pre- and post-antibiotic impregnated eras. Multivariate Cox proportional hazards models were constructed to evaluate whether or not DM was independently associated with IPP infection in the time periods before (1995-2003) and after (2004-2014) the widespread availability of antibiotic impregnated penile prostheses.

Results

14,969 patients underwent initial IPP insertion during the study period. The overall infection rate was 343/14,969 (2.3%). Infections occurred at a median 3.9 months after implant (IQR: 1.0-25.0 months). In the pre-antibiotic impregnated IPP era, infection rates in diabetic and non-diabetic men were 5.2% (78/1,497) and 3.2% (139/4,360), respectively (p<0.001). In the contemporary era of antibiotic impregnated IPPs, infection rates in diabetic and non-diabetic men were 2.0% (55/2,803) and 1.1% (71/6,309), respectively (p=0.002). On multivariate analysis controlling for age, comorbidity index, and annual surgeon volume, DM was an independent predictor of IPP infection in both the pre- (HR 1.43, 95% CI 1.08-1.88, p=0.013) and post-antibiotic impregnated (HR 1.69, 95% CI 1.19-2.41, p=0.004) eras.

Conclusions

Our analysis strongly supports the notion that DM is a risk factor for IPP infection. In the contemporary era of antibiotic-impregnated devices, IPP recipients with DM are at 1.7-fold increased risk of infection compared with non-diabetic men. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control prior to surgery.

Funding

None