(170) ASSESSMENT OF C-REACTIVE PROTEIN AND PROCALCITONIN VALUES MAY AVOID EXPLANT IN EQUIVOCAL FINDINGS FOR IPP INFECTION
Authors: Roth B , Ljubetic B , Bole R , Bajic P 
Published: December 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) is the gold standard surgical treatment for erectile dysfunction. IPP infections require device removal and may lead to permanent erectile dysfunction and penile size loss. Infection is a clinical diagnosis made based on the presence of pain, fevers, chills, swelling, redness, tethering and fluctuance or purulence. However, postoperative exam findings may be equivocal, and hematologic testing could help support the need for explanation vs observation in borderline cases. C-reactive protein (CRP), a marker of inflammation, and procalcitonin, a marker of infection, may help to differentiate infection from inflammation.

Objective
To evaluate whether CRP and procalcitonin can be utilized to avoid explant in the setting of equivocal exam findings in suspected penile prosthesis infection.

Methods
We retrospectively reviewed records from a single surgeon at a tertiary care center from 2020-2023. Patient were identified if they had exam findings or clinical history concerning for possible IPP infection. Records were then further queried to determine if explant occurred or if the patient was successfully managed nonoperatively. CRP and/or procalcitonin lab values around the time of presentation were obtained and trended, where applicable. CRP and procalcitonin categorical ranges (eg, normal, mild, moderate, marked, or severe elevation), as defined by clinical standards, were compared between groups. Age, Charlson Comorbidity Index (CCI), and IV antibiotic choice at initial surgery were also compared. Fisher’s exact test was utilized to compare categorical outcomes, while independent t-test or Wilcoxon rank sum test were used to compare continuous variables.

Results
A total of 209 patients (n = 202 virgin cases, 96.7%) received IPP implant during the study period. Of these, 21 (10%) presented with concern for IPP infection with only 5 patients (2.4%) ultimately requiring explanation. When compared to the explanted cohort, patients who were successfully managed nonoperatively had significantly higher frequency of initial normal CRP/procalcitonin, or experienced down trending values (93.75% vs 40%, p = 0.03, Table 1). Negative predictive value of these tests was 71.4%. Age, CCI, and intravenous (IV) antibiotic choice did not differ between groups (Table 1).

Conclusions
In patients presenting with concern for IPP infection, obtaining and trending procalcitonin and CRP lab values, in concordance with other standard infectious labs such as a complete blood count, may help a urologist determine if a patient truly requires explant. This may be especially true in cases of suspected IPP infection when postoperative signs and symptoms are equivocal. Future, prospective studies are required to determine the predictive value of these laboratory tests in a larger, more diverse population.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation; Boston Scientific.