Prior Radiation Therapy is Associated With Increased Risk of Intraoperative Complications in Patients Undergoing Primary Inflatable Penile Prosthesis Placement: Results From a Large Multi-institutional Collaborative

Abstract

Objective: To investigate intraoperative and postoperative outcomes following primary inflatable penile prosthesis (IPP) implantation among patients with or without prior history of pelvic radiation therapy (RT).

Methods: We conducted a multicenter, retrospective analysis of men undergoing primary IPP placement between July 2016 and July 2021. Among 3530 patients, 211 had a history of RT. After 1:1 propensity score matching for all confounding variables, we compared intraoperative and postoperative outcomes between irradiated and non-irradiated cohorts. Chi-square and Mann-Whitney U tests were used for statistical analysis for categorical and continuous variables, respectively. For multivariable analysis, we used a multivariate logistic regression model. Kaplan-Meier analysis was used to evaluate postoperative complication-free survival.

Results: Patients with prior RT had higher intraoperative complication rates (4.3% vs 0.9%, P=.032), particularly distal crossover events (1.9% vs 0%, P=.044). On multivariable analysis, history of prior RT in the setting of radical prostatectomy (OR 5.95, 95% CI 1.17-30.3, P=.032) and history of diabetes mellitus (OR 9.09, 95% CI 2.29-37.0, P=.002) were associated with increased odds of intraoperative complications. Conversely, obesity was associated with reduced odds (OR 0.10, 95% CI 0.01-0.82, P=.032). No significant differences were observed in postoperative complications or reoperation rates over 24 months.

Conclusion: Prior RT is associated with an increased rate of intraoperative IPP complications. Postoperative complication and reoperation rates were similar to control cases.