Risk of unfavorable outcomes after penile prosthesis implantation - results from a national registry (INSIST-ED).

Like all surgeries, penile prosthesis implantation (PPI) has the potential for both postoperative complications and suboptimal patient satisfaction. In order to assess risk factors for poor satisfaction, we reviewed patients who had been prospectively recruited in a national multi-institutional registry of penile prostheses procedures (INSIST-ED) from 2014 to 20121. Patient baseline characteristics and postoperative complications were recorded. The primary endpoint of this study was unfavorable outcomes after inflatable PPI, defined as significant postoperative complications (Clavien-Dindo ≥2) and/or Sexuality with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) scores below the 10th percentile. A total of 256 patients were included in the study. The median age was 60 years (IQR 56-67). The most common cause of erectile dysfunction (ED) was organic (42.2%), followed by pelvic surgery/radiotherapy (39.8%) and Peyronie's disease (18.0%). Postoperative complications were recorded in 9.6%. High-grade complications (Clavien ≥2) occurred in 4.7%. At 1-year follow-up, the median QoLSPP total score was 71 (IQR 65-76). In all, 14.8% of patients were classified as having experienced unfavorable outcomes because of significant postoperative complications and/or QoLSPP scores below the 10th percentile. Logistic regression analysis demonstrated patient age to be non-linearly associated with the risk of experiencing unfavorable outcomes. A U-shaped correlation showed a lower risk for younger and older patients and a higher risk for middle-aged men. ED etiology and surgical volume were not associated with PPI outcomes. Physicians should, therefore, be aware that middle-aged men may be at higher risk of being unsatisfied following PPI compared to both younger and older patients.

International journal of impotence research. 2023 Oct 31 [Epub ahead of print]

Mirko Preto, Marco Falcone, Natalia Plamadeala, Nicolò Schifano, Carlo Bettocchi, Fulvio Colombo, Stefano Fiordelise, Antonio Vitarelli, Mauro Silvani, Nicola Mondaini, Matteo Paradiso, Carlo Ceruti, Francesco Varvello, Fabrizio Palumbo, Antonio Avolio, Gabriele Antonini, Antonio Corvasce, Diego Pozza, Giorgio Franco, Marco Bitelli, Francesco Boezio, Enrico Conti, Enrico Caraceni, Carlo Negro, Maurizio Carrino, Patrizio Vicini, Nicola Ghidini, Giovanni Alei, Emilio Italiano, Massimiliano Timpano, Massimo Polito, Alessandro Natali, Aldo Tamai, Edoardo Pescatori, Federico Dehò, Blecher Gideon, Paolo Gontero, Alessandro Palmieri, Paolo Capogrosso

Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy. ., Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy., Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy., Department of Urology, University of Foggia, Foggia, Italy., Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy., Andrology Unit, ASL di Piacenza, Piacenza, Italy., Department of Urology, University of Bari, Bari, Italy., Department of Urology, Ospedale di Biella, Biella, Italy., Department of Urology, Villa Donatello Hospital, Florence, Italy., Department of Urology, Ospedale Cardinal Massaia, Asti, Italy., Department of Urology, S. Lazzaro Hospital, Alba, Italy., San Giacomo Hospital, Monopoli, Bari, Italy., Studio di Urologia e Andrologia - Centro Medico Iside, Ascoli Piceno, Italy., Antonini Urology, Rome, Italy., U.O. di Urologia, Ospedale L. Bonomo, Andria, ASL BAT, Italy., Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy., Department of Urology, 'La Sapienza' University of Rome, Rome, Italy., Department of Urology, Frascati Hospital H1, Rome, Italy., Department of Urology, Acquaviva delle Fonti, Bari, Italy., Department of Urology, Levante Ligure Hospital, Italy, La Spezia, Italy., Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy., Department of Urology, Ospedale Evangelico Internazionale Genova, Genova, Italy., Department of Urology, AORN Antonio Cardarelli, Naples, Italy., Department of Urology, Italian Neurotraumatologic Institute Grottaferrata 'I.N.I.', Grottaferrata, Rome, Italy., Andrology Service, Hesperia Hospital, Modena, Italy., Department of Plastic Surgery, Sapienza University of Rome, Rome, Italy., Operative Unit of Urology, Hospital 'Villa Sofia-Cervello', Piazzetta Salerno, Palermo, Italy., Department of Clinical and Specialist Sciences, Division of Urology, Polytechnic University of the Marche Region Medical School, Ancona, Italy., Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Data Clinica, Vicenza, Italy., Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia., Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy.