Dick Brian P, Yousif Ayad, Raheem Omer, Hellstrom Wayne J G
Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Sex Med Rev. 2021 Oct;9(4):628-635. doi: 10.1016/j.sxmr.2020.06.004. Epub 2020 Aug 5.
Hemoglobin A1c (HbA1c), a glycated form of hemoglobin, develops when glucose is elevated in the blood. It is used as a marker of how well a diabetic patient has been controlling their blood sugar over the previous 3-4 months. Some use HbA1c as a predictor of infection risk during prosthetic surgery, and many surgeons require patients to lower it preoperatively.
This study was designed to comprehensively review the literature relating HbA1c and penile prosthesis (PP).
A PubMed search of English-language articles identified studies that investigate the relationship between HbA1c levels and PP infection. Studies were only included if they reported the mean HbA1c of all PP patients and compared patients who did/did not develop a prosthetic infection. References from relevant articles are included.
A total of 6 studies, 1992-2020, were identified. 2 studies occurred before the advent of antibiotic-enhanced devices in the early 2000s and have limited applicability to the modern era. Of the 4 studies published after, 2 reported a significant difference in mean HbA1c when comparing patients who developed a prosthetic infection and those who did not (9.1% vs 7.5%, P = .000 and 9.5% vs 7.8%, P < .001). The other 2 studies reported no significant difference in mean HbA1c when comparing patients who developed a prosthetic infection and those who did not (7.0% vs 7.6%, P > .05; and 7.6% vs 7.5%, P = .598).
Current data regarding HbA1c as a predictor of PP infection are inconclusive, with no consensus. HbA1c is increasingly used as a predictor of postsurgical prosthetic infection, with some urologists requiring patients with elevated HbA1c to acutely lower it before elective surgery. While there are a number of established health benefits of controlling elevated blood sugar, larger randomized controlled trials need to validate whether acutely lowering perioperative HbA1c decreases risk of prosthetic infection. Dick BP, Yousif A, Raheem O, et al. Does Lowering Hemoglobin A1c Reduce Penile Prosthesis Infection: A Systematic Review. Sex Med Rev 2021;9:628-635.
糖化血红蛋白（HbA1c）是血红蛋白的一种糖化形式，当血液中葡萄糖水平升高时会形成。它被用作衡量糖尿病患者在过去3至4个月内血糖控制情况的指标。一些人将HbA1c用作假体手术感染风险的预测指标，许多外科医生要求患者在术前降低该指标。
本研究旨在全面回顾与HbA1c和阴茎假体（PP）相关的文献。
通过在PubMed上搜索英文文章，确定了调查HbA1c水平与PP感染之间关系的研究。仅纳入报告了所有PP患者平均HbA1c水平，并比较了发生/未发生假体感染患者的研究。还纳入了相关文章的参考文献。
共确定了6项2000年至2020年的研究。2项研究发生在21世纪初抗生素增强型装置出现之前，对现代的适用性有限。在之后发表的4项研究中，2项报告在比较发生假体感染的患者和未发生感染的患者时，平均HbA1c存在显著差异（9.1%对7.5%，P = 0.000；9.5%对7.8%，P < 0.001）。另外2项研究报告在比较发生假体感染的患者和未发生感染的患者时，平均HbA1c无显著差异（7.0%对7.6%，P > 0.05；7.6%对7.5%，P = 0.598）。
目前关于HbA1c作为PP感染预测指标的数据尚无定论，未达成共识。HbA1c越来越多地被用作术后假体感染的预测指标，一些泌尿科医生要求HbA1c升高的患者在择期手术前迅速降低该指标。虽然控制血糖升高有许多已确定的健康益处，但需要更大规模的随机对照试验来验证围手术期急性降低HbA1c是否会降低假体感染风险。迪克·BP、优素福·A、拉希姆·O等。降低糖化血红蛋白是否能降低阴茎假体感染：一项系统评价。性医学评论2021；9：628 - 635。
