(218) Bladder Outlet Procedures Performed in Patients with a Penile Prosthesis Do Not Increase Device Complication Rates

Abstract

Abstract Introduction At present, minimal evidence exists in the literature regarding the management of benign prostatic hyperplasia (BPH) in patients with a penile prosthesis. While it is considered prudent to address BPH prior to penile prosthesis placement, no formal guidelines exist on this topic and in many instances, patients develop lower urinary tract symptoms secondary to BPH after prosthesis placement. Thus, understanding how to safely manage BPH in this patient population is key to optimal outcomes. Objective The aim of this study was to understand if patients with a penile prosthesis who subsequently underwent bladder outlet procedures (BOP) had an increased risk of prosthesis complications compared to those patients who underwent BOP prior to their penile prosthesis placement. Methods An Institutional Review Board approved retrospective chart review of all penile prosthesis patients with concomitant BPH from 2008-2023 was undertaken. Men who underwent a BOP before and after penile prosthesis placement were identified and separately analyzed for patient demographics, type of outlet procedure performed, type of prosthesis placed, and complications following penile prosthesis surgery. Complications were defined as any device infections, device malfunctions, or the need for any sort of operative interventions including explant. Statistical analysis was then conducted to identify significant differences between these two cohorts. Results A total of 424 patients with a history of penile prosthesis and BPH were identified. Of this group, a total of 61 patients were found to have undergone a BOP. Specifically, 28 patients were found to have undergone a BOP following their penile prosthesis placement, and 33 were found to have undergone a BOP prior to their penile prosthesis placement. Amongst the two cohorts, there were no statistically significant differences in age, race, prostate volume, hemoglobin A1c levels, type of outlet procedure performed, and history of hypertension, hyperlipidemia, radiation therapy, or smoking. Importantly, there was no statistically significant difference in complication rates between the two cohorts (P=0.910). Conclusions To our knowledge, this study is the largest ever analysis of penile prosthesis patients who underwent bladder outlet procedures. From this data, it seems that patients who undergo BOP after penile prosthesis surgery are not at increased risk for complications compared to those patients who undergo a BOP prior to penile prosthesis surgery. Given that this is a retrospective chart review of a multi-center, high-volume implant practice, further randomized controlled trials will be necessary to confirm these findings. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie.