Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection

Habous, Mohamad; Tal, Raanan; Tealab, Alaa; Soliman, Tarek; Nassar, Mamdouh I.; Mekawi, Z.; Mahmoud, Saad; Abdelwahab, Osama; Elkhouly, Mohamed A.; Kamr, H.; Remeah, Abdallah; Binsaleh, Saleh; Ralph, David; Mulhall, John P.

doi:10.1111/bju.14076

Cited by 74 publications

(32 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent multi-center, prospective study of 902 implants (76% malleable), patients were stratified into HbA1C groups of <6.5%, 6.5% to 7.5%, 7.6% to 8.5%, 8.6% to 9.5%, and >9.5%, with postoperative infection rates of 1.5%, 6.5%, 14.7%, and 22.4%, respectively. Using a receiver operating characteristic curve, a threshold HbA1c level of 8.5% was identified to indicate increased postoperative risk of IPP infection [33]. We would confer Oxford level of evidence rating 2 for increased risk of postoperative penile prosthesis infection in patients with a perioperative HbA1c >8.5.…”

Section: Patient Factorsmentioning

confidence: 99%

Penile Prosthesis Infection: Myths and Realities

Hebert

Köhler

2019

World J Mens Health

View full text Add to dashboard Cite

Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), Staphylococcus aureus nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), “No Touch” technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.

show abstract

Section: Patient Factorsmentioning

confidence: 99%

Penile Prosthesis Infection: Myths and Realities

Hebert

Köhler

2019

World J Mens Health

View full text Add to dashboard Cite

show abstract

“…A multi-centre prospective assessment of preoperative HbA1c levels in more than 900 patients who underwent implant surgery between 2009 and 2015 has recently been reported. 8 The infection rate was significantly higher in those patients with a high HbA1c level, with multivariable analysis identifying a level of 8.5% (~70 mmol/mol) able to predict infection with a sensitivity and specificity of 80% and 65%, respectively. 8 Interestingly, 17 (65.4%) respondents in the current study employed an upper limit that was equal to or higher than this, whilst three (11.5%) did not preclude patients from undergoing implant surgery based upon their diabetic control at all.…”

Section: Discussionmentioning

confidence: 94%

Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice

Ellul

Bullock

Steggall

et al. 2020

Journal of Clinical Urology

View full text Add to dashboard Cite

Objectives: This study aimed to define contemporary perioperative management of patients undergoing penile implant surgery in the UK. Methods: All consultant urological surgeons responsible for the insertion of penile prostheses in the UK were invited to complete an online survey comprising of 25 questions relating to surgeon demographics, patient selection, preoperative work-up, intraoperative management and postoperative care. Anonymised responses underwent descriptive statistical analysis, with particular focus on measures employed to reduce the risk of perioperative infection. Results: Of the 34 invited surgeons, 26 (76.5%) responded to the survey. The majority reported undertaking between 10 and 30 cases in 2018 ( n=17; 65.4%). A total of 23 (88.5%) respondents reported employing a threshold for diabetic control, although the exact limit varied between surgeons. Most respondents ( n=22; 84.6%) reported routinely sampling urine for microscopy, culture and sensitivity. All but one ( n=25; 96.2%) reported routinely performing cavernosal washouts, with the most common solution being a mixture of gentamicin and vancomycin (42.3%). All reported routinely giving intravenous antibiotics on induction of anaesthesia, and although there was no clear consensus, most surgeons preferentially used an aminoglycoside in combination with one other agent (including penicillins or teicoplanin). Conclusion: The variation in current perioperative management demonstrates a potential need for the development and introduction of evidence-based guidelines to standardise practice nationwide. Level of evidence: 5

show abstract

“…In this scenario, it is essential to look at a prospective study designed to predict the importance of Hb1Ac levels at penile prosthesis infection. Habous et al [ 30 ] recently analyzed 902 patients, who received different types of penile prosthesis, and found that Hb1Ac was significantly related to a higher incidence of infection. They had 80 implants with infection, which means an infection rate of 8.9%.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role

et al. 2021

View full text Add to dashboard Cite

Background Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection. Methods The review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported. Results The mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15–2.04). Conclusions Penile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.

show abstract

Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection

Abstract: Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to the HbA1c level. A threshold HbA1c level of 8.5% is suggested for clinical use to identify patients at increased infection risk.

Cited by 74 publications

References 23 publications

Penile Prosthesis Infection: Myths and Realities

Penile Prosthesis Infection: Myths and Realities

Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice

A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role

Contact Info

Product

Resources

About