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Abstract

Volume 24, Issue 1 (January 2022) 24, 32–39; 10.4103/aja.aja_27_21

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection

Franco Palmisano1, Luca Boeri2, Riccardo Ievoli3, Josvany Sánchez-Curbelo4, Matteo Giulio Spinelli2, Andrea Gregori1, Antonio Maria Granata1, Eduard Ruiz-Castañé4, Emanuele Montanari2, Joaquim Sarquella-Geli4

1 ASST Fatebenefratelli-Sacco, Department of Urology, Luigi Sacco University Hospital, Milan 20157, Italy
2 IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, University of Milan, Milan 20122, Italy
3 Department of Economics and Management, University of Ferrara, Ferrara 44121, Italy
4 Fundació Puigvert, Department of Andrology, University of Barcelona, Barcelona 08025, Spain

Correspondence: Dr. F Palmisano (franco.palmisano@hotmail.it)

Date of Submission 03-Sep-2020 Date of Acceptance 04-Mar-2021 Date of Web Publication 04-May-2021

Abstract

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as “satisfied,” while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

Keywords: Boston; Coloplast Titan three-piece penile prosthesis; erectile dysfunction; impotence; Inhibizone; patient satisfaction; penile prosthesis; prosthesis infection; rifampin soaking

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