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Prior Radiation Therapy is Associated with Increased Risk of Intra-Operative Complications in Patients Undergoing Primary Inflatable Penile Prosthesis Placement: Results from a Large Multi-Institutional Collaborative
Vikram S. Lyall, MD1, Thomas Alvermann, BS1, James Jones, MD2, Britney Atwater, MD1, Zafardjan Dalimov, MD3, Linley Diao, MD3, David Barham, MD4, Hossein Sadeghi-Nejad, MD5, Robert Andrianne, MD6, Maxime Sempels, MD6, Tung-Chin Hsieh, MD7, Georgios Hatzichristodoulou, MD8, Muhammad Ammad, MD4, Daniar Osmonov, MD9, Aaron Lentz, MD10, Paul Perito, MD11, Alfredo Suarez-Sarmiento, MD11, James Hotaling, MD12, Koenraad van Renterghem, MD13, Sung Hun Park, MD14, Arthur Burnett, MD15, Jonathan Nicholas, MD16, Martin Gross, MD1, Faysal Yafi, MD4, Jay Simhan, MD3
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Boston University Medical Center, Boston, MA, USA, 3Fox Chase Cancer Center, Philadelphia, PA, USA, 4University of California Irvine, Irvine, CA, USA, 5NYU Grossman School of Medicine, New York, NY, USA, 6Centre Hospitalier Universitaire de Liege, Liege, Belgium, 7University of California, San Diego, La Jolla, CA, USA, 8'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany, 9University Hospital Schleswig Holstein, Kiel, Germany, 10Duke University, Durham, NC, USA, 11Perito Urology, Coral Gables, FL, USA, 12University of Utah, Salt Lake City, UT, USA, 13Jessa Hospital, Hasselt, Belgium, 14Sewum Prosthetic Urology Center of Excellence, Seoul, Korea, Democratic People's Republic of, 15Johns Hopkins Hospital, Baltimore, MD, USA, 16Mayo Clinic, Rochester, MN, USA

BACKGROUND: Radiation therapy (RT) can predispose the onset of corporal fibrosis and microvascular vasculopathy. In this study, we assess intra-operative and post-operative outcomes among patients with or without prior history of RT following primary Inflatable Penile Prosthesis (IPP) implantation.
METHODS: We performed a multicenter, retrospective analysis of men undergoing primary IPP placement between January 2015 and December 2022. A total of 3530 patients were identified, of which 3319 had no prior history of RT and 211 patients had history of RT. After 1:1 propensity score matching for all confounding variables, patients with a history of RT were compared to nonradiated patients for intra-operative and post-operative outcomes. Chi-square and Mann-Whitney tests were used for statistical analysis for categorial and continuous variables respectively. For multivariable analysis, we used a forward stepwise model and included significant variables found on pre-operative characteristics of patients. Kaplan-Meier time to event analysis were compared with Mantel-Cox log-rank test. RESULTS: Patients with history of RT encountered more intra-operative complications (4.3% vs 0.9%, p=0.032); specifically, these men experienced more distal crossover events (1.9% vs 0, p=0.044). On multivariable analysis, history of prior RT (OR 5.29, 95% CI 1.07-26.3, p=0.041) and diabetes mellitus (OR 10.5, 95% CI 2.58-43.5, p=0.01) were associated with increased risk of intra-operative complications. History of obesity (OR 0.11, 95% CI 0.01-0.91, p=0.040) reduced risk of intra-operative complications. There was no significant difference in early or late post-operative non-infectious complications between both groups and there was also no significant difference in risk of post-operative complications within 24 months on Kaplan Meier analysis (log rank p=0.9). CONCLUSIONS: In this large multi-institutional cohort, history of RT is an independent predictor of intra-operative complications but not post-operative complications during primary IPP placement. These findings may help inform patient-specific counselling while guiding surgical planning to prevent untoward morbidity following surgery.

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