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.
To evaluate the association between history of ICI, history of prostate cancer treatment (prostatectomy, radiation) and complications of inflatable penile prosthesis (IPP) placement.
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.
The primary outcome was intraoperative complications, and secondary outcome was implant infection.
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.
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 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.
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.
The journal of sexual medicine. 2025 Sep 26 [Epub ahead of print]
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
Department of Urology, Boston Medical Center, Boston, MA 02118, United States., Section of Urology, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States., Section of Urology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States., Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States., Department of Urology, University of California, Irvine, Orange, CA 92868, United States., Department of Urology, University Hospital of Liege, Liege 4000, Belgium., Department of Urology, Johns Hopkins University, Baltimore, MD 84132, United States., Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 84132, United States., Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, 90491, Germany., Department of Urology, University of California, San Diego, La Jolla, CA 92093, United States., Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, M13 9WL, United Kingdom., Department of Urology, Duke University, Durham, NC 27710, United States., Department of Urology, University Hospital Schleswig Holstein, Kiel 24105, Germany., Sewum Prosthetic Urology Center of Excellence, 429 Gangnam-daero, Seoul 135-846, South Korea., Perito Urology, Coral Gables, FL 33134, United States., Department of Urology, New York University School of Medicine, New York, NY 10016, United States., Department of Urology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium., Department of Urology, Mayo Clinic, Rochester, MN 55905, United States.