Comment on Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center | International Journal of Impotence Research

Oct 16, 2024

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We were invited to comment upon the paper, Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center. This is a study of 530 first time inflatable penile prosthesis (IPP) patients over a 15-year period at an inner-city hospital in New York City [1]. The patients were characterized as being lower socioeconomic status, multi-ethnic, and with a high presence of comorbidities. Regrettably, many of the subjects were lost to follow-up after one year. The study collects an admirable amount of data and is very well written, but we believe the opinions generated from analysis of the data are flawed because of an unusually high infection rate (5.5%) and surgical dehiscence occurrence (2.3%). We are wary of the conclusions concerning risk factors for device infection in this study given the unusually high infection rate is such an outlier compared to published studies from other high-volume centers [2,3,4,5].

Some of the risk factors predisposing patients to infection delineated in this study run counter to our conventional wisdom derived from the 50-year history of IPP publications. To wit, these are the very suspect risk factors delineated in the paper.

Infrapubic incision had a significantly higher infection rate. No other paper in the literature has reported this finding.

Estimated blood loss over 25cc was a significant risk factor for infection but the median blood loss of the reoperated patients was only 30cc.

HgbA1C of over 7.4 was significant for increased risk of infection but the median HgbA1C of the uninfected patients was very similar at 6.8.

Patients with Peyronie’s disease (PD) were at higher risk for infection vs patients without PD.

Patients with hypertension were at risk for infection.

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Hawks-Ladds N, Babar M, Labagnara K, Loloi J, Patel RD, Aalami Harandi A, et al. Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center. Int J Impot Res. 2024. https://doi.org/10.1038/s41443-024-00966-8.

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Institute for Urologic Excellence, La Quinta, CA, USA

Steven K. Wilson

Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

Britney L. Atwater & Martin S. Gross

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All authors (SKW, BLA, MSG) have made substantial contributions to this work. All authors (SKW, BLA, MSG) were involved in the acquisition, analysis, and interpretation of data for the work, and all contributed to drafting the manuscript and revised it critically for important intellectual content including final approval of the version to be published. All authors (SKW, BLA, MSG) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Correspondence to Steven K. Wilson.

SKW is a consultant for International Medical Device, Rigicon, Uramix. MSG is a consultant for Coloplast and MenMD. BLA has no disclosures.

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Wilson, S.K., Atwater, B.L. & Gross, M.S. Comment on Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00989-1

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Received: 26 August 2024

Revised: 23 September 2024

Accepted: 03 October 2024

Published: 15 October 2024

DOI: https://doi.org/10.1038/s41443-024-00989-1

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