Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons.

To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach.

A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of six ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a non-verbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario.

The response rate was 15.6% (n=29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (p<0.01). Within each scenario, factors associated with an increased odds of offering surgery included knowledge that a patient with Down Syndrome is high functioning (OR 5.0, CI: 1.4-17.8), that a prior sex offender is currently married (OR 16.5, CI:3.5-99.8), that a litigious patient sued a surgeon for a retained sponge (OR 6.3, CI:1.7-24.3), and that a nonverbal patient had expressed prior interest in penile prosthesis surgery (OR 4.5, CI: 1.3-16.2).

Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.

Urology. 2020 Dec 04 [Epub ahead of print]

Charan Mohan, Elizabeth Sonntag, Mark Ehlers, Jason Akerman, Solomon Hayon, Brad Figler, R Matthew Coward

School of Medicine, University of North Carolina., Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Department of Urology, University of North Carolina, Chapel Hill, NC, USA., Department of Urology, University of North Carolina, Chapel Hill, NC, USA; UNC Fertility, Raleigh, NC, USA. Electronic address: .

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