Penile prosthesis implantation

Measuring glucose and HbA1c in diabetic patients prior to surgery is not necessary; new antibiotic prophylaxis regimen for diabetic patients; report on ongoing studies on patient satisfaction after penile implantation.

Urologists may be reluctant to implant an inflatable penile prosthesis (IPP) in diabetic patients because of higher risk for infections [1]. Common practice is to screen patients for glycated haemoglobin A1c and blood glucose prior to surgery. Dr Mahmoud Osman et al. (Assiut University, Egypt) demonstrated that this precaution is not necessary and that comorbidity scores are a better predictor for infections and other complications. In support, the work of Dr Mohamad Habous et al. (Jedda, Saudi Arabia) similarly affirmed that the Charlson Comorbidity Index is a stronger predictor of outcome in 716 diabetic patients undergoing IPP in 15 US institutes and in a retrospective series (n=218) by high-volume surgeons in Jedda.

The current American Urology Association guidelines for antibiotic prophylaxis in the prevention of infections in diabetic patients that have undergone a penile prosthesis recommend gentamicin and vancomycin. A study by Prof. Thomas Ahlering and colleagues (University of California at Irvine, USA) showed that when you use this protocol there is a very high 7.7% infection rate, but when you add fluoroquinolone to the combination it drops to 1%. This abstract might be practice-changing and guideline-changing in the near future.

Which patient will benefit the most from IPP implantation?

Dr Frederico Dehò et al. (Università Vita-Salute San Raffaele, Italy) presented an abstract of the Italian registry of penile implants, currently at 265 patients operated on by 45 surgeons [2]. This study showed that patients with post-pelvic surgery or radiotherapy are more satisfied with their surgery and are reported higher quality of life measures when operated at high-volume centres. This prospective registry is now being expanded to the European setting within the PHOENIX study registry. There was a call to all urologists who perform implants to please get involved with PHOENIX for the best opportunities to improve best practice. Endpoints of PHOENIX will be patient satisfaction score at 12 weeks and 1 year after implantation, and then subsequently every 2 years of follow-up for 9 years.

1. Lipsky MJ et al. Sex Med. 2019 Mar;7(1):35-40.
2.  Pescatori E et al. Arch Ital Urol Androl. 2016 Jul 4;88(2):122-7.

Posted on 21 May, 201917 March, 2021