title: Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin.
abstract: OBJECTIVE
  Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion.
  
  
  METHODS
  We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%.
  
  
  RESULTS
  Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes.
  
  
  CONCLUSIONS
  Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.
authors.affiliation: Southwest Impotency Center, Van Buren, Arkansas, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Wilson
authors.forename: C C
authors.initials: CC
authors.lastname: Carson
authors.forename: M A
authors.initials: MA
authors.lastname: Cleves
authors.forename: J R
authors.initials: JR
authors.lastname: Delk
mesh_terms: D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D015917:Penile Prosthesis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood* / Q000150:complications
chemical_list: D006442:Glycated Hemoglobin