Login to Access Video or Poster Abstract: MP25-14
Sources of Funding: None

Introduction

We sought to describe practice patterns and outcomes of surgery performed for treatment of inflatable penile prosthesis (IPP) infections in New York State, and to investigate the impact of surgeon factors on management strategies.

Methods

The New York Statewide Planning and Research Cooperative System database was queried for men who underwent IPP insertion from 1995 to 2014. Operations for IPP infections were identified by diagnostic and procedural codes and characterized as explant or salvage; salvage procedures were divided by device reimplanted (semi-rigid vs IPP). Chi-squared and logistic regression analyses were used to identify surgeon factors associated with undergoing salvage versus explant.

Results

14,969 men underwent IPP insertion. Of these, 343 (2.3%) had surgery for IPP infection at a median 3.9 months. Patterns of IPP infection management and outcomes are depicted in Figure 1. Salvage procedures were used in 21% of cases (72/343). There were no infections after salvage with semi-rigid implants, whereas the infection rate after salvage with IPP was 25% (13/52) (p=0.01). Ultimately, 85% of those who underwent salvage surgery and only 19.6% of those treated by explant ended up with a penile prosthesis (p<0.001). The initial implanter performed the operation for infected IPP in 233 cases (68%). The rate of salvage was higher after 2004 once antibiotic impregnated IPPs were in widespread use (27% vs 18%, p=0.04), when reoperation was performed by the initial implanter (26% vs 11%, p=0.004), and when reoperation was performed by a high volume implanter (p<0.001). On multivariate analysis, salvage was less common when the operation for infection was not performed by the original implanter (OR 0.42, p=0.04) or was performed by a low volume implanter (≤2/year vs >20/year, OR 0.21, p=0.01).

Conclusions

Men treated for infected IPPs with salvage procedures are far more likely to end up with a prosthesis than those treated with explant. Despite these favorable functional outcomes, salvage of infected IPPs is an underutilized strategy. We identified surgeon factors that may partially explain this suboptimal practice pattern. Proactive referral of patients with IPP infections to their original surgeons or to experienced implanters could improve functional outcomes for affected patients.

Funding

None