(178) Exploring Intraoperative and Postoperative Penile Prosthetic Complications in the Solid Organ Transplant Population: A Propensity-Score Matched Analysis
Authors: Johnson J , Alzweri L 
Published: February 2024

Abstract

Introduction
Solid-organ transplant (SOT) patients are highly susceptible to adverse post-operative outcomes given they are on one or multiple immunosuppressant medications. This makes surgeons performing elective surgeries, such as penile prosthetic implant surgery, understandably concerned given the higher risk of potential infection and perioperative complications. However, data regarding the safety and efficacy related to the penile prosthesis in the SOT population is mixed. Our study aimed to analyze adverse intraoperative and post-operative complications related to the penile prosthesis using the TriNetX database.

Objective
To observe whether SOT patients experienced more intraoperative and postoperative penile prosthetic complications when compared to the general population using the TriNetX US Collaborative Network, a large real-world database consisting of deidentified patient data from 56 healthcare organizations across the United States.

Methods
We used the TriNetX database to perform a propensity score-matched cohort study comparing five-year outcomes between SOT patients (kidney, heart, lung, liver, pancreas, and intestine by ICD-10) who underwent either an inflatable or non-inflatable penile prosthetic procedure (SOT) and non-SOT patients who underwent a similar procedure(s) (non-SOT). Patients were excluded from the analysis if they had any instance of priapism (treatment or dx) or Peyronie disease (treatment or diagnosis) in their medical record prior to the penile prosthetic procedure. Cohorts were matched on age, race/ethnicity, CKD, diseases of the prostate or prostatectomy, overweight and obesity status, T2DM, cardiovascular disease, psychiatric disorders, substance-use disorders, and spinal cord injury. Outcomes of interest included intraoperative and perioperative complications as well as post-operative complications related to the prosthetic implant (mechanical malfunction, fibrosis, displacement, hemorrhage, pain, stenosis, removal with or without replacement, and complex [all post-operative complications]).

Results
There were 223 patients in each group after matching (SOT, non-SOT). Mean age at penile prosthesis procedure 60.4 ± 10.2, 52% were White, and 8.9% were Hispanic/Latino. Kaplan-Meier analysis revealed that there was no significant difference found for the incidences of intraoperative complications (0.49% vs 0.53%, p = 0.99). In regards to postoperative complications, we found significantly higher incidences of complex prosthetic complications (28.76% vs 18.28%, p = 0.01) and mechanical malfunction of the penile prosthesis (8.56% vs 3.45%, p = 0.03) in the SOT cohort when compared to the non-SOT cohort. No significant difference was found between the cohorts for 5-year incidences of fibrosis (p = 0.81), hemorrhage (p = 0.97), pain (p = 0.69), stenosis (p = 0.81), infection (p =0.34), displacement (p = 0.68), removal with replacement (p = 0.72), and removal without replacement (p = 0.91).

Conclusions
In our analysis of this large, real-world database, we found that SOT patients were more likely to experience complex penile prosthetic complications as well as mechanical malfunction of the penile prosthesis. However, we observed no difference in 5-yr incidences of stenosis, fibrosis, hemorrhage, pain, infection, displacement, and prosthesis removal between the cohorts. Our analysis reveals that surgeons performing penile prosthetic surgeries, should be aware of potential long-term mechanical malfunction complications related to the penile prosthesis in the SOT population.

Disclosure
No.