MP39-20 PREOPERATIVE HEMOGLOBIN A1C OPTIMIZATION PRIOR TO PENILE PROSTHESIS SURGERY RESULTS IN SUSTAINED LONG-TERM GLUCOSE CONTROL IN DIABETIC MEN

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP39)1 Apr 2020MP39-20 PREOPERATIVE HEMOGLOBIN A1C OPTIMIZATION PRIOR TO PENILE PROSTHESIS SURGERY RESULTS IN SUSTAINED LONG-TERM GLUCOSE CONTROL IN DIABETIC MEN Garrett Thomas*, Kyle Scarberry, Jyoti Chouhan, Parth Thakker, Rahul Dutta, Ethan Matz, and Ryan Terlecki Garrett Thomas*Garrett Thomas* More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , Jyoti ChouhanJyoti Chouhan More articles by this author , Parth ThakkerParth Thakker More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Ethan MatzEthan Matz More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000888.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Uncontrolled diabetes mellitus (DM) has been associated with infection risk following device placement. Diabetic men who elect inflatable penile prosthesis (IPP) for erectile dysfunction (ED) management are required to meet hemoglobin A1c criteria prior to surgery. We hypothesize diabetics who undergo IPP placement after a mandatory delay to improve A1c values maintain better DM control long-term. METHODS: After IRB approval, our prospective IPP database was queried. Data specific to DM management was included for analysis. Men with A1c values at ≥1-year follow-up were included. Univariate statistical analysis was performed using chi square and two-sided t-test. Per institutional protocol, an A1c below 9.0 must be documented prior to IPP surgery. RESULTS: From January 2011 to July 2018, 447 implants were placed, with 131 diabetics identified for analysis. After excluding those without A1c values beyond 1 year of follow-up (n=43), 88 men were included for analysis. Fourteen men (15.9%) were delayed a median of 5 months (range 2-17) due to elevated A1c values (median 10.2%, range 9.1-12%). Median preoperative A1c was higher (8.3 vs. 6.9%) in delayed men (p=0.002). Median age (58 vs. 64), preoperative BMI (33.5 vs. 29.6), and smoking status (21% vs. 10%) were not significantly different between groups (p>0.05). Delayed men were no more likely to require insulin (64.3% vs. 40.5%, p=0.10). Among delayed recipients, insulin dose was increased in 3 (21%) or newly initiated in 3 (21%), while 8 men improved A1c with diet modification or medication adherence. Two men (14.2%) were newly referred to endocrinology. At a median 34 months follow-up, most men maintained A1c values under 9 in both groups (78.6% vs. 85.1%), with similar A1c values reported for both those who did and did not require delay (median 8.1 vs. 7.1%, p=0.11). Insulin requirement at follow-up was higher in delayed men (92.9% vs. 55.4%, p=0.008), but change in BMI was not (median +0.2 vs. 0.0, p=0.99). Device infection occurred in 1 patient (0.8%) whose surgery was not delayed. Complications (Clavien grade I: wound separation in 4 men or urinary retention in 5 men) were no more likely in the delayed group (p=0.68). CONCLUSIONS: IPP placement is safe in diabetic men with preoperative A1c values below 9%. Men motivated to improve DM control to undergo surgery are likely to maintain better glucose levels long-term. Preoperative optimization protocols coupled with restoration of sexual health may lead to improvement in overall wellness. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e584-e584 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Thomas* More articles by this author Kyle Scarberry More articles by this author Jyoti Chouhan More articles by this author Parth Thakker More articles by this author Rahul Dutta More articles by this author Ethan Matz More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...