Presentation Authors: Chirag Dave*, Ahmed Khalaf, Bruce Trock, Arthur Burnett, Baltimore, MD
Introduction: Many patients with neurogenic bladder (NGB) have concomitant erectile dysfunction (ED) and undergo inflatable penile prosthesis (IPP) placement. These patients carry underlying risk factors associated with their disease, but are also predisposed to poor bladder emptying, urinary incontinence and need for prolonged catheterization after surgery. We compared patients with NGB undergoing IPP to a non-neurogenic control group.
Methods: From 2007-2018, 40 patients with documented neurogenic bladder and known concomitant neurologic diagnosis (spinal cord injury, Parkinsonâ€™s disease, multiple sclerosis, diabetes, stroke/brain injury) underwent IPP placement. This group was compared to 162 non-neurogenic control patients undergoing IPP surgery during the same time period with respect to clinical and demographic characteristics as well as surgical outcomes. Chi-square test was used for categorical variables and Wilcoxon rank sum for continuous variables. Poisson regression was used to evaluate relative risk of complications between the two groups, adjusted for confounding factors.
Results: Patients with NGB were significantly younger, had more prior IPP surgeries, were more likely to require urine control management, and had more IPP related complications (infection, erosion, mechanical failure) ((52.5% vs 8%) p < 0.0001). There was no significant difference in the year of surgery, BMI, ethnicity, individual or total number of comorbidities. After adjusting for confounding factors, including age and number of IPPâ€™s, relative risk of complication from IPP was significantly higher with NGB patients vs non neurogenic controls ((RR=2.5)(p < 0.0001))
Conclusions: NGB is an independent risk factor for complications associated with IPP placement. Patients should be counseled accordingly and all efforts should be made to optimize bladder function prior to surgery.