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Body Mass Index and Complication Profiles in Patients Undergoing Inflatable Penile Prosthesis Placement: A Large Multi-Institutional Study
Vikram S. Lyall, MD1, Thomas Alvermann, BS1, Britney Atwater, MD1, Muhammad Ammad, MD2, David Barham, MD2, Nikolaos Pyrgidis, MD, MSc, PhD3, Eliad Amini, MD2, Jake Miller, MD2, Robert Andrianne, MD4, Hossein Sadeghi-Nejad, MD5, Kelli Gross, MD6, Georgios Hatzichristodoulou, MD7, James Hotaling, MD6, Tung-Chin Hsieh, MD8, Aaron Lentz, MD9, Vaibhav Modgil, MD10, Daniar Osmonov, MD11, Sung Hun Park, MD12, Faysal Yafi, MD2, Paul Perito, MD13, Jay Simhan, MD14, Koenraad van Renterghem, MD15, Martin Gross, MD1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2University of California Irvine, Irvine, CA, USA, 3Ludwig-Maximilians-University of Munich, Munich, Germany, 4Centre Hospitalier Universitaire de Liege, Liege, Belgium, 5NYU Grossman School of Medicine, New York, NY, USA, 6University of Utah, Salt Lake City, UT, USA, 7'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany, 8University of California, San Diego, La Jolla, CA, USA, 9Duke University, Durham, NC, USA, 10Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom, 11University Hospital Schleswig Holstein, Kiel, Germany, 12Sewum Prosthetic Urology Center of Excellence, Seoul, Korea, Democratic People's Republic of, 13Perito Urology, Coral Gables, FL, USA, 14Fox Chase Cancer Center, Philadelphia, PA, USA, 15Jessa Hospital, Hasselt, Belgium

BACKGROUND: Obesity, defined as an elevated Body Mass Index (BMI) >30, is a prevalent public health concern with far-reaching implications for various medical procedures and outcomes. In the context of inflatable penile prosthesis placement (IPP), where patient well-being and surgical success are of paramount importance, the impact of obesity on postoperative and intraoperative complications warrants thorough investigation. This study aimed to investigate the impact of BMI on both postoperative and intraoperative complications in an international, multi-institutional cohort of patients who underwent IPP placement. METHODS: We performed a retrospective chart review of 4,398 cases. These cases were divided into two distinct groups based on BMI: less than 30 (n=2,260) and greater than or equal to 30 (n=2,138). The study assessed various surgical factors as well as complications, including overall complications, corporal scarring, incontinence, intraoperative complications, proximal perforation, distal perforation, proximal crossover, distal crossover, and urethral injury. RESULTS: Our analysis revealed that there were no statistically significant differences in intraoperative or postoperative complications between the two BMI categories. Notably, proximal corporal measurement was significantly higher for > 30 BMI group (9.55 +/- 2.18) compared to < 30 BMI group (9.14 +/- 2.19), (p = < 0.001). The incidence rates for overall complications (30.2% vs. 28.7%; p=0.164), corporal scarring (18.2% vs. 16.7%; p=0.36), incontinence (3.53% vs. 3.13%; p=0.076), intraoperative complications (1.94% vs. 1.68%; p=0.253), and specific complications all exhibited no significant differences. Similarly, post-operative complications, including both non-infectious (6.99% vs. 6.22%; p=0.215) and infectious (2.61% vs. 1.87%; p=0.165) complications, did not significantly vary between BMI categories.

BMI_CAT1BMI_CAT2T-Test Results
<30>/= 30
Sample Size n (%)2260 (51.4%)2138 (48.6%)
# of Individuals with Complications (All Types)683 (30.2%)614 (28.7%)p=0.164
# of Individuals with Corporal Scarring411 (18.2%)357 (16.7%)p=0.36
# of Individuals with Incontinence80 (3.53%)67 (3.13%)p=0.076
# of Individuals with Intraoperative Complications44 (1.94%)36 (1.68%)p=0.253
Proximal Perforation12 (0.53%)10 (0.47%)p=0.337
Distal Perforation28 (1.23%)23 (1.08%)p=0.289
Proximal Crossover6 (0.27%)3 (0.14%)p=0.159
Distal Crossover6 (0.27%)4 (0.19%)p=0.16
Urethral Injury9 (0.40%)12 (0.56%)p=0.254
# of Individuals with Post- Op Complications204 (9.02%)164 (7.67%)p=0.168
Non-Infectious Post-Op158 (6.99%)133 (6.22%)p=0.215
Infectious Post-Op59 (2.61%)40 (1.87%)p=0.165
# of Individuals with Rear Tip Extender1430 (63.3%)1364 (63.8%)p=0.21
Rear Tip Extender Length1395 (61.7%)1334 (62.4%)p=0.66
Proximal Corporal Measurement9.14 (+/- 2.19)9.55 (+/- 2.18)p= <0.001

CONCLUSIONS: Our findings indicate that BMI does not exert a statistically significant influence on postoperative and intraoperative complications in the context of high-volume prosthetic urology. In the absence of any other differences between patients of differing BMIs, surgeons may need to be mindful of pump tubing length concerns in obese patients.
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