(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
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.031 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".