James M Jones, David W Barham, Martin S Gross, Chrystal Chang, Muhammed Hammad, Daniel Swerdloff, Jake Miller, Charles Loeb, Robert Andrianne, Arthur L Burnett, Kelli Gross, Georgios Hatzichristodoulou, James M Hotaling, Tung-Chin Hsieh, Lawrence C Jenkins, Adam Jones, Aaron C Lentz, Vaibhav Modgil, Daniar Osmonov, Sung H Park, Ian Pearce, Paul Perito, Hossein Sadeghi-Nejad, Maxime Sempels, Alfredo Suarez-Sarmiento, Jay Simhan, Koenraad van Renterghem, Jonathan Nicholas Warner, Matthew Ziegelmann, Faysal A Yafi, On Behalf Of The Pump Prosthetic Urology Multi-Institutional Partnership Collaborators
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Patients were stratified by development of intraoperative complications (crossover, corporal perforation, or urethral injury) and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications and postoperative infection.</p><p><strong>Outcomes: </strong>The primary outcome was intraoperative complications, and secondary outcome was implant infection.</p><p><strong>Results: </strong>A total of 2540 patients met inclusion criteria. Intraoperative complications occurred in 36 (1.4%) patients. On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, P = 0.03; OR 2.27, P = 0.03; OR 2.40, P = 0.04, respectively). Age, body mass index, diabetes, hypertension, vascular disease, smoking, and Peyronie's disease were not predictors of intraoperative complications. 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引用次数: 0
摘要
背景：阴茎海绵体内注射（ICI）治疗勃起功能障碍（ED）和前列腺癌治疗都有发生下体纤维化的风险，这可能使充气阴茎假体的植入更加困难。目的：评价ICI病史、前列腺癌治疗史（前列腺切除术、放疗）与充气阴茎假体（IPP）置入并发症的关系。方法：对2016年至2021年16家机构的原发性IPP病例进行回顾性队列研究。根据术中并发症（交叉、体腔穿孔或尿道损伤）的发生情况对患者进行分层，并评估组间危险因素的差异。采用多变量logistic回归评估术中并发症和术后感染的预测因素。结果：主要结果是术中并发症，次要结果是种植体感染。结果：2540例患者符合纳入标准。36例（1.4%）患者出现术中并发症。在多变量回归中，ICI病史、前列腺切除术和放疗均是术中并发症的显著预测因素（OR 2.11, P = 0.03; OR 2.27, P = 0.03; OR 2.40, P = 0.04）。年龄、体重指数、糖尿病、高血压、血管疾病、吸烟和佩罗尼氏病不是术中并发症的预测因素。没有一个变量是感染的显著预测因子。临床意义：泌尿外科义肢医师应告知患者ICI病史或接受根治性前列腺切除术和/或放疗的前列腺癌治疗与术中并发症风险增加相关。优势与局限性：本研究的优势在于利用了大型、多中心、国际数据集。该研究受到回顾性研究的限制，缺乏ICI治疗类型和持续时间的颗粒数据，以及固有的选择偏差，因为所有病例都是由专门的种植外科医生进行的。结论：在接受IPP放置的男性中，ICI史、根治性前列腺切除术史和放疗史都与术中并发症的风险增加独立相关。
Predictors of intraoperative complications in men undergoing inflatable penile prosthesis placement.
Background: Intracavernosal injection (ICI) therapy for erectile dysfunction (ED) and prostate cancer treatments all carry a risk of corporal fibrosis, potentially making placement of an inflatable penile prosthesis more difficult.
Aim: To evaluate the association between history of ICI, history of prostate cancer treatment (prostatectomy, radiation) and complications of inflatable penile prosthesis (IPP) placement.
Methods: A retrospective cohort study was performed of primary IPP cases from 2016 to 2021 across 16 institutions. Patients were stratified by development of intraoperative complications (crossover, corporal perforation, or urethral injury) and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications and postoperative infection.
Outcomes: The primary outcome was intraoperative complications, and secondary outcome was implant infection.
Results: A total of 2540 patients met inclusion criteria. Intraoperative complications occurred in 36 (1.4%) patients. On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, P = 0.03; OR 2.27, P = 0.03; OR 2.40, P = 0.04, respectively). Age, body mass index, diabetes, hypertension, vascular disease, smoking, and Peyronie's disease were not predictors of intraoperative complications. None of the variables were significant predictors of infection.
Clinical implications: Prosthetic urologists should counsel patients that a history of ICI or prostate cancer treatment with radical prostatectomy and/or radiation are associated with an increased risk of intraoperative complications.
Strengths and limitations: Strengths of this study include the utilization of a large, multicenter, international dataset. The study is limited by retrospective nature, a lack of granular data as to the type and duration of ICI therapy, and inherent selection bias in that all cases were performed by dedicated implant surgeons.
Conclusion: In men undergoing IPP placement, a history of ICI, a history of radical prostatectomy, and a history of radiation are all independently associated with increased risk of intraoperative complications.
期刊介绍：
The Journal of Sexual Medicine publishes multidisciplinary basic science and clinical research to define and understand the scientific basis of male, female, and couples sexual function and dysfunction. As an official journal of the International Society for Sexual Medicine and the International Society for the Study of Women''s Sexual Health, it provides healthcare professionals in sexual medicine with essential educational content and promotes the exchange of scientific information generated from experimental and clinical research.
The Journal of Sexual Medicine includes basic science and clinical research studies in the psychologic and biologic aspects of male, female, and couples sexual function and dysfunction, and highlights new observations and research, results with innovative treatments and all other topics relevant to clinical sexual medicine.
The objective of The Journal of Sexual Medicine is to serve as an interdisciplinary forum to integrate the exchange among disciplines concerned with the whole field of human sexuality. The journal accomplishes this objective by publishing original articles, as well as other scientific and educational documents that support the mission of the International Society for Sexual Medicine.
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