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New Data Regarding HIV Status as a Predictor of Postoperative IPP Infection
Martin S. Gross, MD1, Jared Wallen, MD2, SriGita Madiraju, MD3, Kevin Tayon, MD3, Natan Davoudzadeh, MD4, Harris M. Nagler, MD4, Paul E. Perito, MD5, Ricardo M. Munarriz, MD6, Doron S. Stember, MD4.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Lebanon, NH, USA, 2USF Morsani College of Medicine, Tampa, FL, USA, 3FAU Charles E. Schmidt College of Medicine, Boca Raton, FL, USA, 4Mount Sinai Hospital, New York City, NY, USA, 5Perito Urology, Coral Gables, FL, USA, 6Boston Medical Center, Boston, MA, USA.

BACKGROUND: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements and adoption of antibiotic prophylaxis guidelines. Previous studies have shown that inherent patient health factors can significantly influence inflatable penile prosthesis (IPP) infection. Among these studies are data that indicate that immunocompromised patients are at higher risk for infectious complications. This study compares IPP infection rates in our HIV positive and HIV negative patients.
METHODS: This study is a retrospective analysis of 952 patients who underwent IPP implantation by ten surgeons at three institutions. HIV status was preoperatively reviewed and no patient had viral loads, CD4 counts, or defining illnesses consistent with AIDS. Patient data were compiled after extensive review
of operative reports, inpatient notes, consult notes, and follow-up visits. Age, comorbidities, overall health status, IPP manufacturer, and antibiotic prophylaxis were similar between all patients. We performed univariate statistical analysis to determine if HIV status was a significant predictor of infectious complications.
RESULTS: Of 952 total patients, 25 patients were HIV positive. Twenty-eight patients (3%) in the HIV negative group had postoperative IPP infection. Two of the 25 HIV (4%) positive patients had a post-operative infection. Statistical analysis via Fisher's exact test confirmed the absence of a significant difference in infection rates between HIV positive and negative men (p=0.19).
CONCLUSIONS: HIV status is a not a significant predictor of infectious complications in our series of patients undergoing IPP implantation. To our knowledge this is the largest series of HIV positive patients undergoing IPP implantation in the literature. Our overall infection rate is consistent with previously published large series of implant patients. Further investigation is needed into the role of immune compromise on infection in primary implant and revision implant cases.


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