Synchronous versus Staged Implantation of Inflatable Penile Prosthesis and Artificial Urinary Sphincter: A Nationwide Analysis of Infection and Revision Outcomes

INTRODUCTION: The timing of implantation of inflatable penile prostheses (IPP) and artificial urinary sphincters (AUS) in patients requiring both devices remains controversial, with limited data comparing outcomes between synchronous dual implantation versus staged procedures. OBJECTIVES: To assess the association between timing of IPP and AUS implantation and subsequent rates of device infection, revision, removal, or replacement using real-world administrative claims data. METHODS: Marketscan® research databases from 2007 to 2023. Men undergoing IPP and/or AUS implantation were identified using CPT diagnosis and ICD procedure codes. Patients were stratified into four groups: synchronous dual implantation, solitary implant (IPP or AUS alone), and staged implantation (IPP or AUS first, followed by the other device). The primary composite outcome was device infection, revision, removal, or replacement. Patient demographics and comorbidities were collected. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression models were used to compare outcomes between groups, adjusting for relevant clinical variables. RESULTS: We identified 18,426 men who underwent IPP placement, 4,523 men who underwent AUS placement, and 659 men receiving both implants. Of these, 357 underwent concurrent IPP and AUS implantation, while 302 were implanted in a staged fashion. There was a higher risk of infection when placing two implants compared to placing one implant (HR 1.43 (1.13-1.80), p= 0.0032). However, synchronous placement of IPP and AUS was not associated with an increased risk of reoperation compared to staged placement (HR 1.50 (95% CI 0.87-2.58), p=0.2). CONCLUSIONS: In the largest known cohort study of its kind, synchronous placement of IPP and AUS is not associated with higher rates of reoperation compared to staged placement, supporting the feasibility of concurrent implantation.