Which patient may benefit the most from penile prosthesis implantation?

Penile prosthesis implantation (PPI) has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life (QoL).

We investigated the profile of the patients who may benefit the most from PPI.

Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (INSIST-ED) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and QoL, all patients were re-assessed at 1-yr follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP). High QoL after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the QoLSPP. Logistic regression analysis tested the association between clinical characteristics and high QoL after PPI.

Follow-up data were available for 285 patients [median age 60 years (IQR: 56 - 67)] who underwent PPI. Erectile dysfunction (ED) etiology was organic in 40%(114), pelvic surgery/radiotherapy in 39%(111), and Peyronie's disease in 21%(60) of the cases. Patients showed good overall QoLSPP scores at 1-yr follow-up for Functional (F:22/25), Personal (P:13/15), Relational (R:17/20) and Social (S:13/15) domains. Overall, 27.0%(77) of patients achieved scores consistent with the high QoL definition. These patients did not differ in terms of median age (60 vs. 62); type of prosthesis (IPPs: 95% in both of the cases) and post-operative complications (10% vs. 14%) compared to those with lower QoL score (all p>0.1). At logistic regression analysis ED etiology was the only factor independently associated with high QoL at 1-year after surgery (p = 0.02). Patients treated for Peyronie's disease (OR = 2.62; p = 0.01;95%CI: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications and surgical volume.

PPI is associated with an overall good QoL. The subset of patients affected by ED secondary to Peyronie's disease seemed to benefit the most from PPI in terms of functional outcomes, relationship with their partners and the outside world and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating QoL and satisfaction after PPI should be further implemented in future studies to better define the predictors of optimal satisfaction after PPI. This article is protected by copyright. All rights reserved.

Andrology. 2022 Sep 11 [Epub ahead of print]

Giovanni La Croce, Nicolo' Schifano, Edoardo Pescatori, Enrico Caraceni, Fulvio Colombo, Carlo Bettocchi, Maurizio Carrino, Antonio Vitarelli, Diego Pozza, Stefano Fiordelise, Francesco Varvello, Matteo Paradiso, Mauro Silvani, Nicola Mondaini, Alessandro Natali, Marco Falcone, Carlo Ceruti, Andrea Salonia, Gabriele Antonini, Tommaso Cai, Alessandro Palmieri, Federico Deho', Paolo Capogrosso

Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Viale Borri 57, Varese, 20181, Italy.