National practice patterns for treatment of erectile dysfunction with penile prosthesis implantation - Abstract

PURPOSE: The increase in medical treatment options for the management of erectile dysfunction (ED) has changed how urologists approach ED.

We reviewed contemporary trends in penile prosthesis implantations in the United States with emphasis on practice patterns, demographics, and temporal changes.

MATERIAL AND METHODS: Annualized case log data of penile prosthesis surgeries from (re)certifying urologists were obtained from the American Board of Urology from 2003 to 2012. The CPT code 54400 identified malleable prosthesis surgeries; 54401 and 54405 identified inflatable prosthesis surgeries. Chi-squared test evaluated the association between surgeon characteristics and practice patterns.

RESULTS: A total 6,615 urologists were included in the surgical cohort with a total of 9,558 penile prosthesis placed over this time period. Only 23.9% of urologists reported performing a penile prosthesis operation. 75% of prostheses are performed by surgeons who complete four or fewer a year. Among urologists recording logs, 1.5% considered themselves to be specialists in andrology yet are responsible for a disproportionate 10% of all prostheses implanted (OR=5.9, p< 0.0001). The proportion of inflatable penile prosthesis compared to malleable prosthesis increased twelve-fold over 10 years. The number of prosthesis surgeries logged was skewed toward the most experienced urologists performing more implants than new urologists (OR=1.92, p< 0.0001).

CONCLUSIONS: Although specialists and high volume surgeons perform a disproportionate number of implants, low volume surgeons place the majority of penile prostheses in the United States. Additional research is needed to determine best practices for achieving optimal patient outcomes in penile prosthesis surgery.

Written by:
Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC.   Are you the author?
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.

Reference: J Urol. 2014 Nov 29. pii: S0022-5347(14)05034-4.
doi: 10.1016/j.juro.2014.11.095


PubMed Abstract
PMID: 25457477

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