What is the impact of anxiety and depression on penile prosthesis outcomes? A population-level assessment

Abstract Background Studies have suggested anxiety and depression (AD) may negatively impact wound healing, pain control, health habits, and care compliance. Aside from a single institution, single surgeon study, the impact of AD on outcomes following inflatable penile prosthesis (IPP) surgery has not been studied. Aim To assess the impact of AD on outcomes following IPP surgery on a population level. Methods We retrospectively assessed men ≥18 years old in the United States who underwent IPP surgery between 2005 and 2025 in the TriNetX database. Patients with and without history of AD were compared after matching on 18 pertinent factors. Outcomes We primarily assessed 90-day rates of device infection, reoperation, and all-time rates of reoperation, mechanical failure, and erosion. We secondarily assessed 90-day rates of medical complications and healthcare utilization. Additionally, a subgroup analysis was performed to assess impacts of preoperative AD medications. Outcomes were compared using risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI). Results Of 15 803 men undergoing IPP surgery, 3386 (21.43%) had a history of AD and 3132 remained in each cohort after matching. At 90 days, AD was associated with a 79% and 42% increased risk of infection (RR = 1.79, 95% CI = 1.26, 2.55) and reoperation (RR = 1.42, 95% CI = 1.05, 1.93), respectively. Any time after IPP surgery, AD was associated with a 17% and 33% increased risk of reoperation (RR = 1.17, 95% CI = 1.02, 1.35) and mechanical failure (RR = 1.33, 95% CI = 1.08, 1.65), respectively. Patients with AD also experienced significantly faster time to mechanical failure (HR = 1.27, 95% CI = 1.02, 1.58). Additionally, AD was associated with significantly increased risk of certain medical complications and healthcare utilization. AD medications did not ameliorate these risks. Clinical implications This study suggests that AD may negatively impact outcomes following IPP surgery, which prosthetic urologists should be aware of. Strengths and limitations This is the first study to assess the impact of AD on IPP surgery outcomes utilizing a population-level approach. Limitations include relying on administrative codes to define study variables and being unable to distinguish indications for reoperation. Conclusion Prosthetic urologists should consider screening for AD prior to IPP surgery, as there appears to be a significant association with AD and IPP outcomes.