Centers of Excellence Concept and Penile Prostheses: An Outcome Analysis

Henry, Gerard D.; Kansal, Neil S.; Callaway, Mark; Grigsby, Tobin; Henderson, J. Nathan; Noble, James S.; Palmer, Thomas H.; Cleves, Mario A.; Ludlow, John K.; Simmons, Caroline J.; Mook, T. M.

doi:10.1016/j.juro.2008.10.157

Cited by 89 publications

(49 citation statements)

References 20 publications

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“…4,5 The paper by Lotan et al 4 stressed that out of 180 cases done in an academic teaching institution, superior results were achieved by the higher volume surgeons. Also in line with the premise of this manuscript, Henry et al 5 studied the 'center of excellence model,' where one surgeon in a large group performs all of the penile implants and other surgeons similarly take on a niche role. Not unexpectedly, this model delivered superior results in that study.…”

Section: Discussionmentioning

confidence: 99%

“…Not unexpectedly, this model delivered superior results in that study. 5 Best practice recommendations for IPP surgery are in evolution, and there remain legitimate variations in how urologists treat their surgical erectile dysfunction patients. The existence of differences in patient outcomes between high and low volume IPP surgeons has been demonstrated in at least two reports.…”

Section: Discussionmentioning

confidence: 99%

“…2 Nonetheless, IPPs remain subject to complications such as infection, erosion, and mechanical malfunction. 3 It has been suggested 4,5 that surgeon and facility volume of IPP implantation may influence patient outcomes. [6][7][8] We sought to use a practice pattern questionnaire to identify what differences in technique, if any, exist between surgeons with a low volume of penile prosthesis implantations (LVI) and those with a high volume (HVI).…”

Section: Introductionmentioning

confidence: 99%

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Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

2010

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Inflatable penile prostheses (IPPs) are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume. A written questionnaire was distributed to 1968 urologists. Responses were collated and analyzed. Respondents were defined as high volume implanters (HVIs) if they placed X20 IPPs in the year preceding the survey, or low volume implanters (LVIs) if they placed p19. Our main outcome measures were surgeon volume, approach to initial IPP placement (penoscrotal vs infrapubic), strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only. HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. There are significant differences in the self-reported practice patterns of HVIs and LVIs. The importance of these differences for patient outcomes remains undefined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

2010

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“…Neither patient wanted to undergo anew implantation procedure, due in part to financial motives (28,29).…”

Section: Fig12 Scrotal Skin Erosion Following Scrotal Abscess In a Dmentioning

confidence: 99%

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

Pozza¹,

Pozza²

2017

ARC Journal of Urology

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“…Many studies regarding the implantation of penile prosthesis have emphasized the importance of success with the first surgery because surgical revision is associated with a worse prognosis and higher rate of complications. (15)(16)(17)(18).…”

Section: Commentsmentioning

confidence: 99%

Penile prosthesis implantation in an academic institution in Latin America

et al. 2010

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Purpose: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. Results: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45% had diabetes, 25.9% had previously undergone radical prostatectomy (RP), and 64% had hypertension. Exchange was performed in 5.7% for fracture, inadequate size, or extrusion. A total of 24.5% of men had immediate postoperative pain, 7.9% had local infection, and 8.6% had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64%) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2%) had sexual intercourse one to two times per week. One hundred twenty patients (86.3%) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. Conclusion: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

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Centers of Excellence Concept and Penile Prostheses: An Outcome Analysis

Abstract: The center of excellence concept in penile prosthesis surgery appears to deliver superior surgical outcomes in terms of shorter operative time, longer cylinders and fewer iatrogenic complications.

Cited by 89 publications

References 20 publications

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

Penile prosthesis implantation in an academic institution in Latin America

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