Commentary on: "Penile prosthesis infection and diabetes mellitus: a systematic review and meta-analysis"

Background The preoperative glycemic control of diabetic patients may increase the risk of penile prosthesis (PP) infection, but the published literature remains controversial. Aim To systematically review and meta-analyze available evidence on the impact of diabetes mellitus (DM) and glycemic control on PP infection. The study was completed under the auspices of the European Society for Sexual Medicine Surgical Academy. Methods An comprehensive Medline, Embase, and Cochrane search was performed including the keywords: (“penile prosthesis” and “diabetes mellitus”). Only English-language articles published between January 1, 1969 and May 31, 2024 were included. Outcomes The primary outcome measure was the risk of PP infection in diabetic patients. The secondary outcome measure was the contribution of glycemic control on PP infection rate. Results Out of 182 retrieved articles, 11 were included in the study, summarizing 10024 subjects with a mean age of 59.7 years, and a mean follow-up of 37.2 months. Overall, a PP infection rate of 4.3[3.9-4.8]% was observed. The PP infection rate increased according to baseline HbA1c levels, and the latter result was confirmed following adjustment for age and trial duration (P<.0001). Accordingly, PP infection rate was more than 2-times higher when trials with a mean HbA1c ≥ 8% were compared to the rest of the sample (9.1[7.5;11.0] vs 3.8[3.2;4.5]%; Q=43.18; P<.0001). Clinical implications Optimization of the preoperative glycemic control may reduce PP infection rate in diabetic patients. Strengths and limitations The present study provides evidence supporting a significant increased risk of PP infection for patients with DM and pre-operative HbA1c≥8%. Analysis was primarily derived from retrospective studies, which represent a significant source of bias. The exclusion of those studies including less than 70% of diabetic patients can represent a further source of bias. Conclusion The present study shows a significant association between pre-operative HbA1c and PP infection rate. Further studies are advisable in order to better clarify the best threshold of HbA1c that is acceptable prior to implant surgery in diabetic patients.