Presentation Authors: Marc Nelson*, Ryan Dornbier, Eric Kirshenbaum, Emanuel Eguia, Patrick Sweigert, Marshall Baker, Joe Mahon, Ahmer Farooq, Kevin McVary, Gopal Gupta, Larissa Bresler, Maywood, IL
Introduction: Erectile dysfunction (ED) is a common, morbid complication of radical pelvic surgery in males. For those that fail non-surgical management of ED, penile prosthesis placement is considered a durable, permanent treatment of impotence. Little is known about the rates of utilization of penile prosthesis and patient characteristics following radical prostatectomy or radical cystectomy.
Methods: The Healthcare Cost and Utilization Project State Inpatient Database (SID) and State Ambulatory Surgery Database (SASD) for Florida from 2009-2015 was utilized. ICD-9 procedure codes were used to identify men who underwent radical prostatectomy or radical cystectomy between 2009 and 2013. Patients were tracked longitudinally for ambulatory or inpatient penile prosthesis surgery. Patient and clinical data were extracted and analyzed with descriptive statistics. A multivariable logistic regression model was utilized to determine risk-adjusted predictors of penile prosthesis placement.
Results: 20,726 males underwent radical prostatectomy and 2,352 males underwent radical cystectomy during the study period. 4.0% and 2.1% of patients had subsequent prosthesis placement, respectively. Prosthesis was placed at an average of 754 days following prostatectomy and 517 days following cystectomy. Patient characteristics for each subgroup can be seen in Table 1. Adjusted risk factors for prosthesis following prostatectomy included Black race (OR 1.43, p < 0.005) Hispanic race (OR 3.27, p < 0.005), Medicare insurance (OR 1.71, p < 0.005), and open surgery (OR 1.37, p < 0.005). Adjusted risk factors for prosthesis following cystectomy included Hispanic race (OR 4.59, p < 0.005).
Conclusions: Despite known impotence rates following radical prostatectomy and radical cystectomy approaching 40%, penile prosthesis is only utilized seldomly in these patients. Further investigation is warranted to determine barriers to prosthetic adoption.