Systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role

Background: Infection is the most feared complication of penile prosthesis. Diabetes mellitus is a well known to increase risk of several kinds of infection, but its role upon penile prosthesis is not defined. The aim of this systematic review is to show the contemporary scenario of penile prosthesis infection and perform a meta-analysis about diabetes mellitus contribution to penile prosthesis infection. Methods: the review was performed with no language or time limitation, in 10 data bases. There were included articles about male population who received a penile prosthesis with no model restriction, with a minimum follow up of one year and proper outcomes report. Results: The mean incidence of infection after penile prosthesis implant ranged from 0.33 to 11.4%. In early 2000, after several improvements, the general incidence of infection was 3 to 5%. Then, the introduction of coated materials decreased infection to 0.3 to 2.7% . Also, no touch technique and centers of reference with high volume surgeons contributed to reduce infection rates. Meta-analysis showed that diabetes mellitus increases penile prosthesis infection with odds ratio of 1.56 (95% CI: 1.12 - 2.044). Conclusions: Penile prosthesis infection decreased in the last decades, but remains an important cause of reoperation and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus increases penile prosthesis infection and it should be considered as a risk factor.