Impact of Prior Radiation Therapy on Intra-Operative Complications in Penile Prosthesis Surgery: Ultrasound Insights

Radiation therapy (RT) is known to increase the risk of corporal fibrosis and microvascular damage, which can contribute to erectile dysfunction. This study aimed to assess the impact of prior RT on intra-operative and post-operative outcomes in patients undergoing primary Inflatable Penile Prosthesis (IPP) placement. A retrospective, multicenter analysis was conducted involving 3530 patients between January 2015 and July 2021. Of these, 3319 had no history of RT, while 211 had previously received RT. After matching for confounding variables using propensity score analysis, intra-operative and post-operative outcomes were compared between the two groups. Results indicated that patients with prior RT experienced significantly more intra-operative complications (4.3% vs 0.9%, p=0.032), particularly distal crossover events (1.9% vs 0%, p=0.044). Multivariable analysis revealed that prior RT (OR 5.29, 95% CI 1.07–26.3, p=0.041) and diabetes (OR 10.5, 95% CI 2.58–43.5, p=0.01) were independent risk factors for increased intra-operative complications. Conversely, obesity was found to reduce intra-operative risk (OR 0.11, 95% CI 0.01–0.91, p=0.040). However, no significant differences were found in early or late post-operative non-infectious complications, and the risk of post-operative complications within 24 months did not differ significantly between the two groups (log-rank p=0.9). These findings suggest that while a history of RT increases the risk of intra-operative complications during IPP placement, it does not appear to affect post-operative outcomes. This information can aid in patient counseling and surgical planning to minimize risks during surgery.