免疫缺陷并不会增加可充胀性 penile 假体修复手术的再手术率。
Immune Deficiency Does Not Increase Inflatable Penile Prosthesis Reoperation Rates.
机构信息
Department of Urology, Weill Cornell Medicine, New York, NY, USA.
Department of Population Health Science, New York, NY, USA.
出版信息
J Sex Med. 2021 Aug;18(8):1427-1433. doi: 10.1016/j.jsxm.2021.06.005. Epub 2021 Jul 22.
INTRODUCTION
Immunocompromised patients are postulated to have higher rates of post-operative infection. We sought to determine if inflatable penile prosthesis (IPP) reoperation rates (due to infection, erosion, device malfunction or patient dissatisfaction) are higher among immunocompromised men.
METHODS
We analyzed men who underwent initial IPP insertion from 2000 to 2016 in the New York Statewide Planning and Research Cooperative System database. Immunocompromised patients were propensity-score matched in a 1:3 fashion with immunocompetent patients. We estimated and compared reoperation rates (including removal, reoperation due to infection, revision, or replacement of an IPP after an index procedure) at 30 days, 90 days, 1 year and 3 years of follow up between immunocompromised men and controls by performing a Kaplan Meier analysis and Log-rank tests. Cox proportional hazards models were built to examine the overall association between immune deficient status and the risk of reoperation.
MAIN OUTCOME MEASURE
Reoperation rate and time to reoperation after index IPP placement.
RESULTS
A total of 245 immunocompromised patients who received an initial IPP between 2000 and 2016 were identified. After propensity score matching, we analyzed 235 immunocompromised men and 705 controls. There was no difference in overall reoperation rates between immunocompromised men and controls within any time period assessed (30 days, 90 days, 1 year, or 3 years). In our Cox proportional hazards model, the hazards of overall reoperation, removal, or revision/replacement (HR 1.11 [95% CI 0.74-1.67], HR 1.58 [95% CI 0.90-2.79)], and HR 0.83 [95% CI 0.47-1.45], respectively) were not significant different between immunocompromised men and controls. Reoperation due to infection was also not significantly different between immunocompromised and immunocompetent men (HR 2.06 [95% CI 0.97-4.40]).
STRENGTHS & LIMITATIONS: This study is strengthened by its size as the largest cohort of immunocompromised men treated with IPP to date in the literature, but is limited by the retrospective nature of the database which may introduce selection bias and by the low event rate for IPP reoperation.
CONCLUSIONS
Reoperation rates, including those due to infection, are not significantly different between immunocompromised men and immunocompetent controls. Therefore, immune status in appropriately selected candidates does not appear to place patients at substantially higher risk of explant or revision. Gaffney CD, Fainberg J, Aboukhshaba A, et al. Immune Deficiency Does Not Increase Inflatable Penile Prosthesis Reoperation Rates. J Sex Med 2021;18:1427-1433.
简介
据推测，免疫功能低下的患者术后感染率更高。我们旨在确定免疫功能低下的男性中，因感染、侵蚀、器械故障或患者不满意而进行可充式阴茎假体 (IPP) 再次手术的比率（由于感染、翻修、设备故障或患者不满意）是否更高。
方法
我们分析了 2000 年至 2016 年期间在纽约州计划和研究合作系统数据库中接受初次 IPP 植入的男性。采用倾向评分匹配法，将免疫功能低下的患者按 1:3 的比例与免疫功能正常的患者进行匹配。我们通过 Kaplan-Meier 分析和对数秩检验，比较了免疫功能低下的男性和对照组在术后 30 天、90 天、1 年和 3 年随访时（由于感染、翻修、更换 IPP）的再次手术率（包括移除、因感染而进行的再次手术、修复或更换 IPP）。建立 Cox 比例风险模型以评估免疫缺陷状态与再次手术风险之间的总体相关性。
主要观察指标
IPP 植入后的再次手术率和再次手术时间。
结果
共确定了 2000 年至 2016 年间接受初次 IPP 植入的 245 名免疫功能低下患者。在进行倾向评分匹配后，我们分析了 235 名免疫功能低下的男性和 705 名对照者。在评估的任何时间段内，免疫功能低下的男性与对照组之间的总再次手术率均无差异（30 天、90 天、1 年或 3 年）。在我们的 Cox 比例风险模型中，总体再次手术、移除或修复/更换的风险（HR 1.11[95%CI 0.74-1.67]，HR 1.58[95%CI 0.90-2.79]）和 HR 0.83[95%CI 0.47-1.45]）在免疫功能低下的男性和对照组之间无显著差异。免疫功能低下的男性与免疫功能正常的男性之间，因感染而进行的再次手术也无显著差异（HR 2.06[95%CI 0.97-4.40]）。
优势与局限性
这项研究的规模较大，是迄今为止文献中最大的一组接受 IPP 治疗的免疫功能低下男性队列，因此其优势在于此。但该研究也存在一定的局限性，如数据库为回顾性研究，可能存在选择偏倚，且 IPP 再次手术的发生率较低。
结论
免疫功能低下的男性与免疫功能正常的对照组之间，再次手术率（包括因感染导致的再次手术）无显著差异。因此，在适当选择的患者中，免疫状态似乎不会显著增加假体取出或翻修的风险。Gaffney CD、Fainberg J、Aboukhshaba A 等。免疫缺陷不会增加可充式阴茎假体再次手术率。J 性医学 2021；18：1427-1433。
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