(033) Where Is the Sweet Spot? HbA1c Thresholds and Its Impact on Infection Rates in Penile Prosthesis Surgery: A Systematic Review & Single-Arm Meta-Analysis
Notice bibliographique
Résumé
Abstract Introduction Penile prosthesis implantation is a definitive surgical treatment for end-stage erectile dysfunction, offering high patient satisfaction rates. However, post-operative infection remains a serious complication, often necessitating device explantation and revision surgery. Although poor glycaemic control is generally associated with increased infection risk, its specific impact on prosthetic urology procedures is not well established. Pre-operative HbA1c, reflecting average blood glucose over 2-3 months, may serve as a predictive marker for post-operative infection, but current evidence is inconsistent. This systematic review evaluates the association between pre-operative HbA1c levels and infection rates following penile prosthesis implantation. Objective To systematically assess whether elevated pre-operative HbA1c levels are associated with increased risk of post-operative infections in patients receiving penile prosthesis implantation, and to identify a potential HbA1c threshold value for surgical risk stratification. Methods A systematic review was performed according to PRISMA guidelines. Comprehensive searches of multiple databases were conducted, and studies were screened independently by two reviewers using Covidence. Data extraction and organization were completed in Microsoft Excel, and statistical analyses were performed using SPSS. Primary outcomes included comparisons of pre-operative HbA1c between infection and non-infection cohorts. Odds ratios (OR) were calculated to estimate infection risk in diabetic versus non-diabetic patients. Locally estimated scatterplot smoothing (LOESS) was used to explore non-linear relationships between HbA1c and infection rates. The Newcastle Ottawa Scale (NOS) was used to assess risk of bias. Results From 41 identified studies, 13 met inclusion criteria (2 prospective and 11 retrospective observational studies), providing data on 6964 patients. The pooled infection rate across studies was 4% (95% CI: 0.02–0.07). The mean HbA1c in patients with infection was 0.64% higher than in those without infection (95% CI: -0.07–1.35). The odds ratio for infection in diabetic versus non-diabetic patients was 1.54 (95% CI: 0.79–3.04), indicating a clinically relevant but statistically non-significant increase. Subgroup analysis using an HbA1c threshold of 7.5% demonstrated a three-fold increase in infection rates (2% vs. 6%). Visual inspection of LOESS curves suggested an incremental rise in infection risk starting at a HbA1c threshold around 7.5%. Sensitivity analyses revealed no single study disproportionately influenced the findings. Conclusions Pre-operative HbA1c is a key marker reflecting glycaemic control and correlates with infection risk after penile prosthesis implantation. Our review shows that higher HbA1c levels are associated with increased post-operative infection rates. A HbA1c threshold near 7.5% appears reasonable for risk stratification, but further large-scale prospective studies with patient-level data are needed to establish optimal cut-offs. Disclosure No
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».