(349) Risk Factors for Revision of Inflatable Penile Prosthesis among an Ethnically Diverse Urban Population

Abstract

Abstract Introduction Inflatable Penile Prosthesis (IPP) is an increasingly popular surgical treatment for refractory erectile dysfunction. However, there is a feared complication of infection or need for revision surgery. While the risk, treatment, and prevention of infections following IPP placement has been studied, few studies have reported on the risk factors for revision of implant, particularly among a diverse urban population with high rates of comorbid conditions. Objective To identify risk factors for revision surgery after primary IPP implantation among an ethnically diverse urban population with high rates of comorbid conditions. Furthermore, to aid informed consent of patients with refractory erectile dysfunction considering IPP surgery. Methods This study was a retrospective review of patients receiving IPP implantation surgery at a large urban hospital between January 2015 and December 2021. The primary outcome was revision or removal of IPP due to infection, device malfunction, or other. Patient characteristics, implant characteristics, intraoperative factors, and 30-day outcomes were compared between groups via Chi-squared, student’s t-test, or Mann-Whitney U test. A multivariate cox regression survival analysis was used to identify risk factors for revision surgery. A Kaplan-Meier survival curve was calculated for identified risk factors. Results A total of 489 patients received IPP implantation within the study period with 50 (10.2%) requiring revision surgery. Twenty-two (44.0%) patients had removal or revision of IPP due to infection, 19 (38.0%) due to device malfunctions, and 9 (18.0%) due to other reasons. The average time to revision surgery was 8.7 +/− 2.03 months. History of smoking was identified as a risk factor for revision surgery (p<.01), with 23% of active smokers and 13% of former smokers requiring revision surgery. Active smokers had a 3-fold higher risk of requiring revision surgery (OR: 3.23 [0.35-1.32], p<.01). The use of Arista hemostatic agent, as opposed to Surgicel or Evicel, resulted in a more than 50% reduction in the risk of revision surgery (p<.01). However, this finding fell out of our model when adjusted for smoking status (p=.072). Other characteristics such as age, BMI, race, comorbid conditions, length of surgery, implant size, use of surgical drain, and 30-day outcomes were not associated with risk of revision surgery. Conclusions There is a mounting body of evidence associating history of smoking with revision surgery and infection following IPP implantation surgery. Patients with active smoking history should be counseled on the up to 3-fold increased risk of requiring revision surgery. Additionally, further studies should assess the use of hemostatic agents such as Arista in reducing risk of revision surgery. Disclosure No