Available outcomes on penile prosthetic surgeries are mainly based on cohort studies from single institution or high volume surgeons. Previous studies have shown the short-term reoperation rate of penile prostheses was 7.4% at 4 years (1,2). The evaluation of the long-term reoperation rate of penile prosthetic surgery utilizing large contemporary population-based databases is lacking.
We sought to describe the long-term reoperation rates of penile prosthetic surgery utilizing the State of California Office of Statewide Health Planning and Development database over fifteen-year period (1995-2010).
This study demonstrated the 5- and 10-year cumulative reoperation rates were 11.2% (CI = 10.5-12.0) and 15.7% (CI = 14.7-16.8), respectively (Figure 1).
Figure 1. Reoperation rate of penile prosthesis
Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year postoperatively and steadily decreased until 2 years postoperatively. Multivariate analysis showed higher rates of reoperation in younger men (hazard ratio [HR] = 1.51, CI = 1.12-2.05), African-American men (HR = 1.30, CI = 1.05-1.62), and Hispanic men (HR = 1.32, CI = 1.12-1.57) (Table. 1).
Table 1. Multivariate Predictors of Reoperation Rate*
Of the reoperations, 29% reoperations occurred at a hospital different from the initial surgery.
To conclude, this is the largest longitudinal study evaluating the true reoperation rate of penile prosthetic surgery using large population database. Data suggests that reoperation rate of penile prosthetic surgery is highest in the first year postoperatively. With more than a quarter of reoperations performed at a different setting, this finding underpins that the existing literature does not reflect the true prevalence of penile prosthetic complications. Future studies on the reoperation rates of penile prosthetics surgery will require geographically broader datasets, aiming to establish practice patterns in the various surgical settings across the United States.
*Adjusted for but not listed are nutritional deficiencies, obesity, anemia, disorders involving the immune system, hospital teaching status, prostatic cancer, pelvic surgery, neurogenic bladder, and year of initial penile prosthesis implantation
Written By:
Omer A. Raheem, MD, MSc Anat, MCh Urol, MRCS; and Tung-Chin Hsieh, MD
Department of Urology, University of California, San Diego, California, United States
REFERENCES
Grewal S, Vetter J, Brandes SB, et al. A population-based analysis of contemporary rates of reoperation for nile prosthesis procedures. Urology 2014; 84:112.
Carson CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of follow-up. J Urol 2011; 185:614.