(678) Beyond BMI: Rethinking Infection Risk and Functional Outcomes in Penile Prosthesis Surgery

Introduction While obesity has historically been perceived as a surgical risk factor, evidence regarding its influence on penile prosthesis outcomes remains mixed. Body habitus may alter tissue exposure, pump positioning, and device handling-factors that could influence mechanical or infectious complications beyond traditional metabolic risk. This study evaluates whether increased body mass index (BMI) impacts postoperative complications and re-operation rates following inflatable penile prosthesis (IPP) implantation. Objective To compare infection, mechanical, and functional complication rates between men with BMI < 28 and ≥ 29 undergoing primary IPP placement. Methods A retrospective review of 165 IPP cases was performed. Patients were stratified by BMI (< 28 vs ≥ 29) based on the obesity criteria. Demographics, surgical variables, and postoperative outcomes were collected. Complications were categorized as infection (implant, cellulitis, urinary tract infection, superficial), wound, re-education, difficult operation, supersonic transport (SST) deformity, cosmetic, pain, sensation change, urethral injury, or mechanical malfunction. Re-operations included device removal, replacement, or revision. Results A total of 165 patients were included (BMI <28 = 81; ≥29 = 84). Infection-related events occurred in 4.9% of lower-BMI and 2.4% of higher-BMI patients. When subcategorized, true implant infections-defined as infections requiring device removal or replacement-occurred in two patients (2.5%) within the lower-BMI cohort and none in the higher-BMI cohort, for an overall true infection rate of 1.2% (2/165). Superficial cellulitis occurred in 2.5% vs 1.2%, while urinary tract infection was observed only in the higher-BMI group (0% vs 1.2%). Mechanical malfunction occurred in 11/81 (13.6%) of lower-BMI and 8/84 (9.5%) of higher-BMI patients. Among these, five in each group occurred in patients whose primary implant was placed at our institution.Urethral events occurred in 3.7% vs 6.0%, consisting of one urinary retention and one pending urethral erosion in the lower-BMI group, and two confirmed erosions, two pending erosions, and one urinary retention in the higher-BMI group. Pain complaints were more frequent among lower-BMI patients (6.2% vs 1.2%). Re-education (3.7% vs 3.6%), cosmetic concerns (4.9% vs 6.0%), and sensation changes (4.9% vs 3.6%) were similar. True re-operations performed on primary implants placed at our institution occurred in nine patients (11.1%) with BMI <28 and seven patients (8.3%) with BMI ≥29. Additional procedures performed on prostheses originally placed at outside institutions or for non-prosthetic indications (circumcision, penoplasty for SST, scrotal debridement) were excluded from this analysis. No visceral or vascular injuries Conclusions BMI ≥ 29 was not associated with higher infection, mechanical, or re-operation risk following inflatable penile prosthesis placement. True implant infections were rare and occurred only in lower-BMI patients, while overall infection-related events remained low and comparable between groups. Mechanical complications occurred more often in leaner men, whereas urethral events-urinary retention or urethral erosion-were slightly more frequent in higher-BMI individuals, reflecting anatomic and technical factors related to tissue depth rather than infection susceptibility. Postoperative pain was more common among lower-BMI patients but did not reach statistical significance. Overall, these findings suggest that body habitus, rather than BMI alone, may better explain variability in prosthesis function and postoperative comfort. Further prospective studies are warranted to validate these trends. Disclosure No