A Population-based Analysis of Contemporary Rates of Reoperation for Penile Prosthesis Procedures

Abstract

OBJECTIVES To perform a population based comparison of inflatable versus semi-rigid penile prostheses to determine contemporary rates of re-operation and identify factors impacting the type of prosthetic implanted. METHODS Patient level discharge data and revisit files from the Agency for Healthcare Research and Quality for semi-rigid and inflatable prosthesis procedures performed for erectile dysfunction from 2006-2009 in the state of California were examined. Regression analysis was performed to determine differences between the procedures in terms of infectious and non-infectious failure. Regression analysis was performed to identify factors associated with revision and to identify associations between potential risk factors and the type of implant performed. RESULTS A total of 2263 cases were included in the study (1824 inflatable, 439 semi-rigid). The overall re-operation rate was 7.42%. There was no difference in the overall revision rate between the 2 groups (7.52% semi-rigid, 7.40% inflatable, p=0.94). The re-operation rate secondary to infectious complications was 3.6% (4.5% semi-rigid vs 3.23% inflatable, p= 0.18). The revision rate secondary to non-infectious failure was 2.96% in the semi-rigid versus 4.17% in the inflatable group (p=0.25). Medicaid insurance (OR 2.25, CI 1.41, 3.61), African American (OR 1.7, CI 1.20, 2.49) race, age over 80 (p=0.046), and diabetes (OR 1.67, CI 1.07, 2.59) were associated with receiving a semi-rigid implant. CONCLUSIONS Re-operation rates for infectious and non-infectious failure are equivalent between the semi-rigid and inflatable penile prostheses. Socio-demographic factors appear to significantly influence the type of prosthesis a patient receives.

Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection

“…Penile implant infection leads to increased patient morbidity, patient hospital re‐admission, prolonged surgery‐related hospital stay, prolonged use of broad spectrum antibiotics, and implant removal . Grewal et al surveyed patients discharge and re‐visit data in a contemporary series of penile implant surgeries and found that infectious complications were the most common reason for reoperation. Whilst Lledó‐García et al reported high patient and partner satisfaction after both primary and replacement surgery.…”

Hospital-Based Trends in Penile Prosthetic Surgery

“…In addition, Caucasian race was independently associated with receipt of inflatable penile prosthesis, highlighting racial disparities in the surgical management of ED. Racial variation in the selection of penile prosthetic surgery was also described recently using a California administrative data set by Grewal et al in which the authors demonstrated that African-American men were more likely to receive a semi-rigid implant [20]. Lower socioeco-nomic status may account for selection of less expensive, and thus, semi-rigid implant; however, these findings highlight disparities in care warranting further investigation.…”

Trends in the Utilization of Penile Prostheses in the Treatment of Erectile Dysfunction in the United States

“…Grewal et al. [20] similarly noted that ethnicity and Medicaid or self‐pay insurance status were significant predictors for receiving a semirigid prosthesis. The unequal utilization of surgical techniques according to ethnicity has also been previously reported; Yu et al.…”