Hypertension and low cholesterol as risk factors for infection after primary inflatable penile prosthesis surgery

Background: Inflatable penile prosthesis (IPP) is an effective surgical intervention in the treatment of erectile dysfunction. However, infection is a devastating complication of IPP placement. We sought to evaluate the association between medical comorbidities, medications, and serum metabolic lab values, and infection following primary IPP placement in our ethnically diverse population. Methods: A retrospective chart review was performed on all men who had primary IPP placement between 2017-2019 at our institution. Variables collected included patient demographics, medical history, medication usage, and pre- and postoperative lab values, within six months of surgery, including hemoglobin A1c, total cholesterol, and low density lipoprotein. Rates of postoperative infection through 60 days were noted. Patients were grouped either into the infected or non-infected cohort based on postoperative infection status. A Student's unpaired t-test was used to compare numerical variables and a Pearson chi-square test or Fisher's exact test was used to compare categorical variables between the cohorts. Results: A total of 293 men underwent primary IPP placement, of whom 14 (4.8%) were in the infected cohort and 279 (95.2%) in the non-infected cohort. The infected cohort was more likely to have a history of hypertension (92.9% vs 74.2%, p = 0.026) and statins medication usage (78.6% vs 52.0%, p = 0.039) when compared to the non-infected cohort, respectively. The infected cohort had a significantly lower postoperative cholesterol value (136.3 mg/dL vs 170.0 mg/dL, p = 0.024) and postoperative low density lipoprotein (LDL) value (65.2 mg/dL vs 92.1 mg/dL, p = 0.020) when compared to the non-infected cohort, respectively. Conclusions: Hypertension and usage of statin medications were more common in men who developed infection following IPP placement. As hypertension can disrupt microvasculature over time, it may contribute to poor healing post-IPP placement. Future research is warranted to determine statins' anti-inflammatory effect on wound healing and ability to fight infection.