8-year post operative survival after penile prothesis implantation: Less than expected perioperative risk.
Authors: Elgendy Hamed , Hassan Walaa , Alnadhari Ibrahim , Shamsodini Ahmad , Ansari Abdulla Al 
Published: May 2021

Abstract
Background: Penile prosthesis implantation (PPI) is the surgical correction of patients with erectile dysfunction. These patients usually present with multiple co-morbidities such as cardiovascular, cerebral or organ impairment. Objectives: The primary objective of this study is to investigate the survival patterns of the study subjects after PPI, perioperative complications, length of hospital stay and Intensive Care Unit (ICU) admission. The next objective is to analyse the risk factors that contributed to their mortality. Methods: In this observational study, a total of 109 males subjects were enrolled who had all undergone PPI in our institute. They were assigned into either of the two groups -based on their median age-where group 1 consisted of patients ≥ 60 years old, and group 2 consisted of patients< 60 years old.Results: In group1, individuals exhibited: ASA score equal to or higher than 3, more than three co-morbidities and were prescribed to anti-coagulants, P < 0.0001, P = 0.018 , P < 0.0001 respectively. More than half of patients in group-1 had poor diabetic control (HbA1C ≥ 7%). Majority of patients had insertion of the 3-piece Inflatables, Boston/Coloplast, i.e., group-1 was 37/55 (67.3 %), while in group-2, was, 35/54 (64.81 %). The majority of patients in both groups had received spinal anaesthesia with minimal surgical complications. None of the enrolled patients had received inotropic support perioperatively and none of them were admitted to the ICU. There were no perioperative or 60-day mortalities. However, there were two patients in each group- a total of four pateints that had expired. The clinical characteristics of the four deceased patients includedmultiple co-morbidities, being overweight and exhibited major vascular risk diseases or surgeries. Three of the deceased patients exhibited high preoperative HbA1C readings, however, all four patients showed a low preoperative testosterone levels. But it was noted that all four of these pateints they had normal ejection fraction. Three of those patients survived for more than six years postoperatively except for one patient who had expired three months postoperatively, mostly due to a vascular accident. Every patient was admitted for one day postoperatively and none of them were admitted to the ICU. A high preoperative systolic blood pressure, P = 0.028 was significantly associated with mortalityAnd a low preoperative testosterone serum level, P = 0.040 was seen to be the independent risk factor for the patients overall survival. Conclusion: PPI is considered a safe procedure in spite of the elderly individuals presenting with comorbidities. The risk of mortality is still possible due to the presence of those comorbidities, however the probability of it is far more likely to happen in the distant future- post-operatively. Addionally, the optimization of preoperative HTN is required and it can also be concluded that low testosterone levels are an independent risk factor for mortality.