Depression and anxiety are associated with increased complications after penile prosthesis surgery: a retrospective cohort study

Depression and anxiety are often comorbid with erectile dysfunction and are linked to worse surgical outcomes. We aimed to determine if depression/anxiety increased complication rates in inflatable penile prosthesis (IPP) surgery. All IPP cases by a single surgeon at our institution from 2020–2022 were reviewed. Data was collected on demographics, medical/psychiatric history, intraoperative details, and post-operative outcomes. Univariate, multivariate, and survival analysis were performed to assess relationships between patient factors and complications. 279 IPP cases were performed. Anxiety/depression was significantly associated with post operative complications ( p  = 0.002) and infection ( p  = 0.024). Anxiety/depression is independently associated with increased complications in a multivariable logistic regression model including age, BMI, diabetes, primary surgery, smoking status, pelvic surgery, radiation, Peyronie’s disease, and correctly holding anticoagulation. Survival analysis showed that anxiety and depression both resulted in faster times to complication and re-operation (all p  < 0.05). This is the first study assessing the impact of mental health on IPP outcomes. Urologists should consider mental health when evaluating patients for IPP surgery, and mental health treatment prior to surgery may improve outcomes.