National Practice Patterns of Treatment of Erectile Dysfunction with Penile Prosthesis Implantation

Oberlin, Daniel T.; Matulewicz, Richard S.; Bachrach, Laurie; Hofer, Matthias; Brannigan, Robert E.; Flury, Sarah C.

doi:10.1016/j.juro.2014.11.095

Cited by 48 publications

(19 citation statements)

References 25 publications

(28 reference statements)

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“…Urologists may apply for certification by the ABU after completing residency and demonstrating an appropriate level of knowledge and expertise in the management of urological conditions. [5, 6]…”

Section: Methodsmentioning

confidence: 99%

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Oberlin

Flum

Lai

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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Introduction and objectives To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods Six month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using CPT codes for open radical prostatectomy (ORP) and laparosopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained A total of 6,563 urologists submitted case logs, of which 68% (4470/6563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013. Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (p < 0.001). 39% of surgeons logging ORP performed two or fewer RP while 19% of surgeons who performed RALP performed 2 or less RP (p < 0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (p < 0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared to general surgeons (47% vs. 25.9% respectively, p < 0.001). Conclusions Robotic prostatectomies are performed five-times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared to general urologists.

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Section: Methodsmentioning

confidence: 99%

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Oberlin

Flum

Lai

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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View full text Add to dashboard Cite

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“…Both of them have their pros and cons, but currently the inflatable penile prosthesis (IPP) is used more often in North America and Europe than the non-inflatable and there is a trend toward the use of the IPP in the Southern hemisphere. Analyzing case log data of penile prosthesis implanted by (re)certified urologists from the American Board of Urology from 2003 to 2012, Oberlin and colleagues observed that the proportion of the IPP compared with malleable prosthesis increased twelvefold over these 10 years [19].…”

Section: Types Of Penile Prosthesismentioning

confidence: 99%

“…This decision should be taken with both the physician and the patient, and is usually based on the urologist's comfort with surgical approach, assessment of body habitus, presence of associated conditions (e.g., Peyronie's disease, spinal cord injury), manual dexterity of the patient, and overall cost. In most industrialized countries, if cost is not a limiting factor (e.g., reimbursement by third parties), the three-piece IPP is considered the "gold standard," accounting for 70% of implants in the United States [19], while 20% are two-piece (Ambicor™) and 10% are semirigid rods. This is because, despite its somewhat more complex insertion as it requires the placement of the two cylinders, the pump and the reservoir into the abdominal cavity, the three-piece implant gives the best rigidity and flaccidity since it fills every part of the corporal bodies, and its bigger capacity reservoir permits a better emptying of the cylinders avoiding erectile tissue deterioration, as witnessed with self-contained or two-piece devices with no reserve fluid volume [20].…”

Section: Patient and Implant Selectionmentioning

confidence: 99%

Surgical Treatment of Erectile Dysfunction

Bertero¹,

Antunes²

2015

Sexual Medicine Reviews

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“…The surgery offers high patient satisfaction and has a low rate of complications, especially in the hands of an experienced surgeon. Yet, urologists who perform fewer than five implants per year are responsible for 75% of the penile prostheses in the United States ( 1 ). In the United Kingdom, 80% of surgeons who perform the procedure only place one or two penile prostheses per year ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Troubleshooting intraoperative complications of penile prosthesis placement

Sharma¹,

Smith²

2017

Transl. Androl. Urol.

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Placement of a penile prosthesis is an excellent option for well-selected patients, offering high patient satisfaction and a low rate of complications. Most urologists who perform the procedure are not high volume implanters and may have limited experience with troubleshooting intraoperative issues. In this review, the authors use current literature to provide recommendations for the management of various intraoperative issues such as difficultly with dilation, incongruent measurement, perforation, urethral injury, crossover, complications of reservoir placement, penile curvature, glans mobility, and hemostasis are all discussed. Preparedness for the management of intraoperative issues can help improve patient outcomes and limit morbidity.

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National Practice Patterns of Treatment of Erectile Dysfunction with Penile Prosthesis Implantation

Cited by 48 publications

References 25 publications

The effect of minimally invasive prostatectomy on practice patterns of American urologists

The effect of minimally invasive prostatectomy on practice patterns of American urologists

Surgical Treatment of Erectile Dysfunction

Troubleshooting intraoperative complications of penile prosthesis placement

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