(167) INFLATABLE PENILE PROSTHESIS INFECTION IN DIABETIC PATIENTS ON SODIUM-GLUCOSE TRANSPORT PROTEIN 2 INHIBITORS

Abstract Introduction Infections following inflatable penile prosthesis (IPP) placement occur in 1-3% of patients, with increased rates among diabetic patients. Attempts to predict infections using markers like glycosylated hemoglobin, glucose levels, and insulin dependence have yielded inconclusive results. Sodium-glucose transport protein 2 inhibitors (SGLT2i) are among the most commonly prescribed medications in diabetic patients and are associated with possibly increased rates of urinary tract and genital infections. The relationship between SGLT2i and IPP infections in diabetic patients has not yet been explored. Objective Our objective is to identify if diabetic patients taking SGLT2i are at increased risk of an IPP infection. Methods We performed a retrospective review of all diabetic men who underwent IPP placement utilizing MarketScan insurance claims database between 2011-2021. Patients with a diagnosis of diabetes whose medication use we were unable to identify were excluded. Demographic data, including age, smoking status and obesity were obtained. All cases of IPP infection requiring device removal were identified based on ICD-9/10 and CPT codes. Multivariate model outputs were performed to assess the likelihood of IPP infection in diabetic patients on SGLT2i as well as based on demographics. Results A total of 2,383 privately insured diabetic patients who underwent IPP placement were identified. The mean age of the cohort was 61 years (55-66 years), with 18.9% identified as smokers and 61.0% classified as obese. Among these patients, 883 (31.1%) were using a SGLT2i or combination medication. Over a mean follow-up period of 25 months (10-49 months), there were 82 (2.9%) documented cases of infections requiring IPP removal, which included 28 (3.2%) patients on SGLT2i and 54 (2.8%) patients on other medications. SGLT2i use was associated with a nonsignificant increase in the HR [1.26 (p = 0.39)], while smoking and obesity were both associated with significantly increased HRs [2.20 (p < 0.01) and 2.024 (p = 0.02), respectively]. Conclusions These results suggest that preoperative counseling and lifestyle changes, particularly smoking cessation and weight loss, are important to potentially decrease the risk of IPP infections in diabetic patients. Tobacco screening and treatment, nutritional assessments, and guided weight loss plans should be integrated into preoperative management strategies prior to IPP surgery. SLGT2i may be continued perioperatively to ensure appropriate glycemic control as these medications have not been found to be associated with a significantly increased risk of postoperative infections. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Paterna bio, firmtech, Turtle health, maximus, carrot, inherent bio.