QUANTIFYING RISK OF PENILE PROSTHESIS INFECTION WITH ELEVATED GLYCOSYLATED HEMOGLOBIN
Abstract
Purpose:
Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion.
Materials and Methods:
We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%.
Results:
Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes.
Conclusions:
Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.
References
- 1 : The glycosylation of hemoglobin: relevance to diabetes mellitus. Science1978; 200: 21. Google Scholar
- 2 : Correlation of glucose regulation and hemoglobin A1c in diabetes mellitus. New Engl. J. Med.1976; 295: 417. Google Scholar
- 3 : Small-Carrion penile prosthesis: a report on 160 cases and review of the literature. J. Urol.1978; 119: 365. Link, Google Scholar
- 4 : Complications of penile prosthesis surgery for impotence. J. Urol.1982; 128: 1192. Link, Google Scholar
- 5 : Periprosthetic infections. J. Urol.1987; 138: 68. Link, Google Scholar
- 6 : Infectious complications of penile prosthetic implants. J. Urol.1987; 138: 65. Link, Google Scholar
- 7 : Eleven years of experience with the inflatable penile prosthesis. J. Urol.1988; 139: 951. Link, Google Scholar
- 8 : Infectious complications of penile prosthesis surgery. J. Urol.1988; 139: 953. Link, Google Scholar
- 9 : Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J. Urol.1992; 147: 386. Link, Google Scholar
- 10 : Inflatable penile implant infection: predisposing factors and treatment suggestions. J. Urol.1995; 153: 659. Link, Google Scholar
- 11 : Clinical applications of glycosylated hemoglobin measurements. Diabetes1982; 31: 70. Google Scholar
- 12 : Infected penile prosthesis: incidence and outcomes. Int. J. Impotence Res.1989; 1: 175. Google Scholar
- 13 : Management of penile prosthesis infections. Prob. Urol.1993; 7: 368. Google Scholar
- 14 : Late hematogenous infection of penile prostheses. J. Urol.1988; 139: 112. Google Scholar
- 15 :
Diabetic peripheral vascular disease . In: . Bowie, Maryland: Robert J. Brady Co.1981: 281. chapt. 34. Google Scholar - 16 : The development of microvascular complications. Diabetologia1978; 15: 143. Google Scholar
- 17 : Proceedings of the Conference on Diabetic Microangiopathy. Diabetes1976; 25: 805. Google Scholar
From the Southwest Impotency Center, Van Buren, Arkansas, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, and Division of Urology, University of North Carolina, Chapel Hill, North Carolina.
