Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era

Mondaini, Nicola; Sarti, Enrico; Giubilei, Gianluca; Gavazzi, Andrea; Costanzi, Antonio; Belba, Arben; Cai, Tommaso; Bartoletti, Riccardo

doi:10.4081/aiua.2014.3.161

Cited by 14 publications

(4 citation statements)

References 11 publications

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“…For this reason, they do not normally suggest this solution to any patients consulting them during the early phase of the ED diagnostic process. The financial aspect of the surgical treatment of ED may greatly limit the patient' s choice if no other medical treatments are effective (23). The number of patients submitted to PPI appears in line with other distinguished European urological centers (24,25).…”

Section: Discussionmentioning

confidence: 82%

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

Pozza¹,

Pozza²,

Musy³

et al. 2015

Arch Ital Urol Androl

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Objectives: The aim of our study was to report our experience with patients affected by Erectile Dysfunction (ED) and undergoing penile prosthetic implantation (PPI) in a single center by a single surgeon. Material and Methods: We retrospectively evaluated the clinical outcome of 500 patients (mean age: 51.5 years, range: 20-86 years) affected by ED and referred to our private andrological center from January 1984 to December 2013 who underwent penile prosthesis implantation, including the reported level of patient satisfaction. Results: 182 silicone, 180 malleable, 18 monocomponent hydraulic and 120 multicomponents hydraulic prostheses were implanted by the same experienced surgeon. All patients were hospitalized for the procedure. All patients were evaluated immediately, 1 month (496 patients) and, for the great majority, every year after implantation. One hundred twenty five patients were lost to follow-up. Twenty two patients underwent revision surgery for complications in the postoperative period. The most serious postoperative complications were mechanical problems (45 patients, 9.0%) and infection (15 patients, 3%). Forty two (8.4%) prostheses were explanted. Overall, 80% (400/500) of patients were able to have sexual intercourse and were fully satisfied with the results. Conclusions: In our experience prosthetic surgery should be considered a good solution for men affected by ED and not responsive to other therapeutic solutions. Prosthetic surgery can be performed not only in large public hospitals but also in smaller private facilities.

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Section: Discussionmentioning

confidence: 82%

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

Pozza¹,

Pozza²,

Musy³

et al. 2015

Arch Ital Urol Androl

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“…Conceptually, this approach was referred to as oncoplastic surgery, which aims at providing safe oncological treatment through careful preoperative planning and the incorporation of plastic surgery techniques, in order to obtain good oncological control with favourable cosmetic results in cases of large breast volume and large tumours [ 14 ]. In the urological setting, RP offers an attractive opportunity for tumour removal, either as a form of definitive management or as the first step in multimodal therapy [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ]. Furthermore, bilateral nerve sparing, usually carried out in low-risk cases of cancer, is often associated with an increased risk of positive surgical margins in patients with pathologic T2 disease during RP [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prosthesis was then almost fully activated for the first 24 hours with a compressive bandage. All patients stayed for 4 hours in a nurse-operated recovery room [ 12 ]. The drain was removed on day 1 and patients were discharged from the hospital on day 4.…”

Section: Methodsmentioning

confidence: 99%

A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation

Mondaini

Cai

Sarti

et al. 2018

World J Mens Health

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PurposeThere are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction.Materials and MethodsFrom June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life.ResultsTen patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up.ConclusionsLaparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction.

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“…Several large single‐center series have demonstrated the safety and economic advantage of PP insertion in the outpatient setting [9–11], with one series showing a 17% reduction in financial cost [12]. We were interested in understanding the national trends in the number and type of inpatient PP and perioperative outcomes of PP performed in the inpatient setting over time.…”

Section: Introductionmentioning

confidence: 99%

The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000–2010

et al. 2015

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IntroductionAcross all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible.AimsOur aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.MethodsWe analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.Main Outcome MeasuresOur main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.ResultsThere was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatient insertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18–1.78) (P = 0.0001). Surgeries performed in high‐volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high‐volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.ConclusionsThe number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high‐volume center in terms of inpatient complications. Alwaal A, Harris CR, Hussein AA, Sanford TH, McCulloch CE, Shindel AW, and Breyer BN. The decline of inpatient penile prosthesis over the 10‐year period, 2000–2010. Sex Med 2015;3:280–286.

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Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era

Abstract: The outpatient setting for this surgery is safe and effective even in patients with comorbidities or in case of secondary procedures. Costs are reduced by 17%.

Cited by 14 publications

References 11 publications

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation

The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000–2010

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