Prior Radiation Therapy is Associated With Increased Risk of Intraoperative Complications in Patients Undergoing Primary Inflatable Penile Prosthesis Placement: Results From a Large Multi-institutional Collaborative

Abstract

OBJECTIVE To investigate intraoperative and postoperative outcomes following primary inflatable penile prosthesis (IPP) implantation among patients with or without prior history of pelvic radiation therapy (RT). METHODS We conducted a multicenter, retrospective analysis of men undergoing primary IPP placement between July 2016 and July 2021. Among 3530 patients, 211 had a history of RT. After 1:1 propensity score matching for all confounding variables, we compared intraoperative and postoperative outcomes between irradiated and non-irradiated cohorts. Chi-square and Mann-Whitney U tests were used for statistical analysis for categorical and continuous variables, respectively. For multivariable analysis, we used a multivariate logistic regression model. Kaplan-Meier analysis was used to evaluate postoperative complication-free survival. RESULTS Patients with prior RT had higher intraoperative complication rates (4.3% vs 0.9%, P = .032), particularly distal crossover events (1.9% vs 0%, P = .044). On multivariable analysis, history of prior RT in the setting of radical prostatectomy (OR 5.95, 95% CI 1.17-30.3, P = .032) and history of diabetes mellitus (OR 9.09, 95% CI 2.29-37.0, P = .002) were associated with increased odds of intraoperative complications. Conversely, obesity was associated with reduced odds (OR 0.10, 95% CI 0.01-0.82, P = .032). No significant differences were observed in postoperative complications or reoperation rates over 24 months. CONCLUSION Prior RT is associated with an increased rate of intraoperative IPP complications. Postoperative complication and reoperation rates were similar to control cases. UROLOGY 206: 229-234, 2025. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.