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

Abstract

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.

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

“…However, few groups have examined surgical preferences for ED treatment and those available relied on limited national sampling database studies or recall biased practitioner surveys. 10,11 The most relevant study of penile prosthesis practice trends, that by Gee et al, was published 18 years ago. 14 To our knowledge our analysis of case log data from certifying and recertifying urologists is the first evaluation of penile prosthesis implantation surgical case logs in the United States.…”

“…2,3 Several studies suggest that surgeon and facility volumes of prosthesis surgery may influence surgical outcomes. 10,11 However, to our knowledge there has been no contemporary evaluation of the actual surgical practice patterns of penile prosthesis surgery in the United States to date.…”

Deep Venous Thrombosis as a Complication of Reservoir Placement in Post‐Prostatectomy Erectile Dysfunction and Urinary Incontinence Prosthetic Surgery

“…IPPs are done via a penoscrotal or infrapubic incision, while AUSs can be placed perineally or through a penoscrotal incision. Most urologists place IPPs penoscrotally [8], with proponents of the penoscrotal incision noting the ease of exposing the proximal corpora, the negligible risk of dorsal nerve injury, and easier pump placement as reasons to choose this approach. The main drawback to this approach is the need to blindly place the reservoir into the space of Retzius.…”

The future of penile prostheses for the treatment of erectile dysfunction

“…In a simplistic sense, this may relate to an increasing expertise and efficiency on the part of the surgeon, but it is equally likely that improvements in systems (e.g., operating room staff that are knowledgeable about the procedure, established treatment pathways for surgical patients, etc.) also contribute to these superior outcomes (15). Penile implants are no exception to this general rule of surgical outcomes; ergo, it may be preferable that penile prosthesis surgery not be performed by "dabblers" but rather by individuals who have had intensive training and/or extensive experience with implant surgery.…”