QUANTIFYING RISK OF PENILE PROSTHESIS INFECTION WITH ELEVATED GLYCOSYLATED HEMOGLOBIN

Purpose: Elevation of glycosylated hemoglobin above levels of 11.5 mg. % has been considered a contraindication to penile prosthesis implanta tion in diabetic patients. We determine the predictive value of glycos ylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion. Materi als and Methods: We conducted a 2-year prospective study of 389 patien ts, including 114 diabetics, who underwent 3-piece penile prosthesis i mplantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C lev el. 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 increa sed infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increa sed infection risk with increased levels of glycosylated hemoglobin A1 C among all patients or among only the diabetics. In fact, there was n o meaningful difference in the median or mean level of glycosylated he moglobin A1C in the infected and noninfected patients regardless of di abetes. Conclusions: Use of glycosylated hemoglobin A1C values to iden tify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin de pendence also does not increase risk of infection in diabetics undergo ing prosthesis implantation.