To identify comorbid conditions that may increase the likelihood of revision surgery after primary penile prosthesis implantation. To evaluate trends in prosthesis utilization and device selection within the Veterans Affairs (VA) system.
A retrospective review of the VA Informatics and Computing Infrastructure (VINCI) database was performed using Current Procedural Technology (CPT) codes to identify any Veteran who underwent penile prosthesis surgery between January 2000 and December 2013. Age, race, procedure type and relevant comorbidities were identified and compared between groups.
6,586 patients underwent primary penile prosthesis placement with at least 1 year of follow up. Peripheral vascular disease (p<.001), smoking (p<.001), hypertension (p=0.012) and history of prostate cancer (p=0.043) were each associated with a significant increased risk of revision or removal surgery. There was an increase in overall number of implants placed during the study and increased durability with MPP, but there was a downward trend in number of MPP placed relative to IPP (p<.001). MPP were more likely to be placed with increasing age (p<0.05) and there was a trend towards increase MPP placement in African-Americans compared to Caucasians (p=0.06).
Peripheral vascular disease, hypertension, smoking and history of prostate cancer are associated with increased risk for secondary surgery. This raises a provocative question of how vascular insufficiency may play a role in the likelihood of secondary surgery after penile prosthesis placement. Utilization of penile prosthesis placement in the VA system is steadily increasing, most notably with increased numbers of IPP placement.
Urology. 2016 Jun 30 [Epub ahead of print]
John Lacy, Jonathan Walker, Shubham Gupta, Daniel L Davenport, David Preston
Cleveland Clinic, Cleveland, OH. Electronic address: ., Department of Urology, University of Kentucky, Lexington, KY; Veterans Affairs Medical Center, Cooper Drive Division, Lexington, KY., Department of Urology, University of Kentucky, Lexington, KY; Veterans Affairs Medical Center, Cooper Drive Division, Lexington, KY., Department of Surgery, University of Kentucky, Lexington, KY., Department of Urology, University of Kentucky, Lexington, KY; Veterans Affairs Medical Center, Cooper Drive Division, Lexington, KY.