Abstract: PD22-11
Sources of Funding: none

Introduction

Uncontrolled diabetes mellitus (DM) marked by elevated glycosylated hemoglobin A1c (HBA1c) values, has been correlated in some studies with an increased rate of infection after penile implant surgery. This study aimed to explore the association between HbA1C level and penile implant infection and to define if a cut-off value existed

Methods

Between 2009-15 HbA1c levels were obtained on all patients undergoing penile implant surgery. Preoperative, perioperative and postoperative management was identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. HbA1c levels were analyzed as a continuous variable and sequential analysis was conducted utilizing 0.5% increments to define a cut-off level predicting implant infection. Multivariable analysis was performed with the following factors entered into the model: Diabetes yes/no; HbA1C level; patient age; implant type; vascular risk factor number; presence of PD; BMI and surgeon volume. A ROC curve was generated to define the optimal HbA1C cut-off for infection prediction

Results

902 implant procedures have been performed over this period of time. The mean HbA1c level = 8 ± XX%, with 81% of men having HbA1c >6%. Mean age = 56.6 years. 685 (76%) implants were malleable, and 217 (24%) were inflatable. 302 (33.5%) patients had also a diagnosis of PD. Overall infection rate was 8.9% (80/902 subjects). Patients who had implant infection had significantly higher mean HbA1c levels, 9.5% vs 7.8% (p<0.001). Grouping the cases by HbA1c level we found infection rates were: 1.3% with HBA1c <6.5%, 1.5% @ 6.5-7.5%, 6.5% @ 7.6-8.5%, 14.7% @ 8.6-9.5%, 22.4% @ >9.5%. (p<0.001). Patient age, implant type, and vascular risk factor number were not predictive. Predictors defined on MVA were: PD, increased BMI, high HbA1C while a high-volume surgeon had a protective effect and was associated with a reduced infection risk. Using ROC analysis, we found that a serum HBA1C cut-off level of 8.5% predicted infection with a sensitivity of 80% and a specificity of 65%

Conclusions

Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to HbA1C level. A threshold value of 8.5% is suggested for clinical use to identify patients at increase infection risk

Funding

none