1. Sustained Glycemic Control Observed in Diabetic Men Who Improve Hemoglobin A1c Values to Allow for Elective Penile Prosthesis Placement.
- Author
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Scarberry KA, Thomas GM, Cowper M, Chouhan JD, Thakker PU, Matz EL, Dutta R, and Terlecki RP
- Subjects
- Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Type 2 complications, Elective Surgical Procedures standards, Erectile Dysfunction blood, Erectile Dysfunction etiology, Follow-Up Studies, Glycemic Control standards, Humans, Male, Middle Aged, Penile Implantation standards, Penile Prosthesis adverse effects, Postoperative Complications blood, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Treatment Outcome, Diabetes Mellitus, Type 2 blood, Elective Surgical Procedures adverse effects, Erectile Dysfunction surgery, Glycated Hemoglobin analysis, Penile Implantation adverse effects, Postoperative Complications prevention & control
- Abstract
Objectives: We hypothesize that men with diabetes mellitus whose inflatable penile prosthesis (IPP) implantation is delayed for unacceptably high hemoglobin A1c (HbA1c) will have durable improvements in their glycemic control after achieving acceptable HbA1c levels for surgery., Methods: Per institutional protocol, an A1c <9% must be documented prior to IPP placement. After IRB approval, a single surgeon IPP database was retrospectively queried for data specific to diabetes mellitus management. Men without HbA1c values at ≥1-year follow-up were excluded. Univariate and multivariate statistical analyses were performed to assess associations with sustained HbA1c control., Results: From January 2011 to March 2019, 138 diabetics undergoing IPP were identified. Thirty-seven were excluding for insufficient follow-up. Nineteen of the 101 analyzed men (18.8%) were delayed a median 4 months (range 2-17) for elevated HbA1c values (median 10.1, range 9.1-12.3). Following improvements, median preoperative HbA1c remained higher (8.2% vs 7.0%) in delayed men (P < .001). Among delayed recipients, 11 (58%) improved without medication changes while insulin was newly initiated (5) or dosage was increased (5) in 42%. At 32 months follow-up, a HbA1c <9% was similarly maintained in delayed and nondelayed men (74% vs 87%, P = .17). Delayed men more commonly required insulin therapy at follow-up (89.5% vs 54.9%, P = .008), but had a similar median change in BMI (+0.1 vs +0.1, P = .65). Device infection occurred in 1 nondelayed patient (0.7%)., Conclusion: Men who improve HbA1c for IPP surgery are likely to demonstrate persistent improvement. IPP implantation appears to be safe in diabetic men with HbA1c <9%., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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