(285) Outcomes of Penile Prosthesis Implantation in Patients with Obesity: A Systematic Review of Complication Risks and Concurrent Aesthetic Procedures

Abstract Introduction Obesity, defined as a body mass index (BMI) ≥30, is highly prevalent among men with erectile dysfunction (ED). This association presents two distinct clinical challenges of increases the risk of perioperative complications, particularly infectious complications and presence of a prominent suprapubic fat pad in obese men often results in a "buried penis" deformity, which reduces perceived penile length and negatively impacts patient satisfaction following PPI. Objective To systematically review the available evidence on the impact of BMI ≥30 on perioperative complications of PPI, and the safety, efficacy, and satisfaction rates of performing simultaneous PPI with aesthetic procedures (e.g., abdominoplasty, suprapubic lipectomy) to address buried penis in obese patients. Methods A total of six studies met the inclusion criteria and were included for synthesis. Inclusion criteria were studies reporting on: (1) PPI complications stratified by BMI (particularly comparing BMI ≥30 vs. BMI <30), or (2) outcomes of simultaneous PPI and abdominoplasty/suprapubic lipectomy. Data on complication rates (infectious and non-infectious), reoperation rates, patient satisfaction (e.g., Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS]), and postoperative changes in perceived penile length were extracted and synthesized. Results Large-scale, multi-institutional data from 4,398 patients showed no significant differences in intraoperative, postoperative non-infectious, or infectious complication rates between obese (BMI ≥30) and non-obese (BMI <30) patients undergoing penile prosthesis implantation, findings further supported by a smaller cohort of 50 patients with similar outcomes regardless of BMI or diabetes control. Additionally, three case series involving 32 patients demonstrated that simultaneous penile prosthesis implantation with abdominoplasty or suprapubic fat pad excision is a safe and effective option for selected obese patients with buried penis, yielding low infection rates (overall 9.4%), a mean perceived penile length gain of up to 2.8 cm, and high satisfaction rates (85%). For aesthetic procedures in patients with a pre-existing prosthesis, preoperative ultrasound is essential to locate the reservoir and avoid device injury. Conclusions Contrary to historical concerns, this review finds that elevated BMI alone does not significantly increase the risk of perioperative complications in PPI surgery. Furthermore, for obese patients with a "buried penis" secondary to suprapubic lipodystrophy, simultaneous PPI with abdominoplasty or suprapubic lipectomy is an emerging, safe, and effective approach that significantly improves perceived penile length and patient satisfaction. This dual-procedure strategy warrants consideration as a viable treatment option for carefully selected obese patients with refractory ED and significant suprapubic fat pads, though meticulous patient counseling regarding realistic expectations, the theoretical increased risk of complications such as infection, and the importance of prolonged drain placement remains essential. Disclosure No