Hypogonadism Associated With Higher Rate of Penile Prosthesis Infection: An Analysis of United States Claims Data

Objective: To understand the relationship between hypogonadism and penile prosthesis infection risk.

Methods: We performed a retrospective analysis using IBM MarketScan Commercial Claims and Encounters database. We identified men with ED diagnosis who underwent penile prosthesis placement from 1/1/2008 to 12/31/2017. Comorbidities and risk factors were identified along with a diagnosis of hypogonadism. After placement of penile prosthesis, men were followed until date of surgery of penile prosthesis explant due to infection. Cox proportional hazards models from time of penile prosthesis surgery to date of infection adjusting for various known confounding factors were run.

Results: We identified 16,660 men who had received penile prosthesis during the study period. 4,832 (29.0%) men had a hypogonadism diagnosis at the time of their initial surgery date. There were 421 (2.5%) device infections requiring explanation. Descriptively, a higher percentage of infections were noted for removal and replacement surgeries compared to primary implants. Hypogonadism was independently associated with a 25.8% higher risk of penile prosthesis infection (HR: 1.258, 95% CI: 1.024-1.546). Among those men who received testosterone therapy for hypogonadism (prescription data within 0-30 days and within 0-90 days of their initial implant surgery), the effect of hypogonadism on infection risk was no longer significant.

Conclusions: Untreated hypogonadism was associated with a 26% higher risk of penile prosthesis infection. This association was most pronounced in men undergoing removal and replacement surgery, which likely drives this association. This suggests a possible benefit to testosterone therapy in testosterone deficient men prior to penile implant, specifically in men undergoing revision.