Depression and Anxiety are Associated with Increased Complications after Penile Prosthesis Surgery

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 penile prosthesis surgery. All penile prosthesis 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. Fisher’s exact test was used to compare complications amongst patients when sorted by categorical variables. Complications were analyzed as time to event outcomes using Kaplan-Meier methods. Multivariable logistic regression was used to measure the effect of mental health on complications while controlling for potential confounders. 284 penile prosthesis cases were performed. Anxiety/depression was significantly associated with post operative complications (p = 0.002) and infection (p = 0.025). Anxiety/depression is independently associated with increased complications in a multivariable logistic regression model including age, BMI, diabetes, primary surgery, smoking status, 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 penile prosthesis outcomes. Urologists should consider mental health when evaluating patients for prosthesis surgery, and mental health treatment prior to surgery may improve outcomes.