Modern Utilization of Penile Prosthesis Surgery

A National Claim Registry Analysis

RL Segal; SB Camper; AL Burnett


Int J Impot Res. 2014;26(5):167-171. 

In This Article

Abstract and Introduction


The objective of this study was to evaluate the modern utilization of penile prosthesis surgery based on data derived from national claim databases and contrast to an analysis of patients similarly treated at an academic center during a contemporaneous period. A retrospective claim analysis utilizing a national database (MarketScan, Thomson Reuters) was performed for Commercial insurer and Medicare databases between January 2000 and March 2011. A retrospective analysis of contemporaneous penile prosthesis implantation at the Johns Hopkins Hospital (JHH) was done. Population demographics, comorbidities, previous (ED) therapies and time from ED diagnosis to surgery were assessed. Median ages for patients undergoing penile prosthesis implantation were 58, 70 and 63 years for the Commercial, Medicare and JHH cohorts, respectively. For the claim databases (Commercial, Medicare, respectively), hypertension (72%, 78%), dyslipidemia (71%, 56%) and diabetes mellitus (45%, 40%) were predominant comorbidities, whereas for the JHH database prostate cancer (51%) and its management by prostatectomy (45%) or radiation (12%) were predominant. Previous use of PDE5 inhibitors was similar across databases (60, 58 and 69% for Commercial, Medicare and JHH cohorts, respectively), although previous use of non-oral ED therapies was greater in the JHH database. Median time to surgery from initial ED diagnosis was 2, 2 and 4 years for the Commercial, Medicare and JHH patients, respectively. Demographic variables and ED risk factors associated with penile prosthesis surgery at a national population-based level over a contemporary period were defined. Some differences in utilization trends of penile prosthesis surgery exist at a single institutional level.


Organic erectile dysfunction (ED) is a sign and consequence of systemic illness and can severely impact quality of life. Risk factors include aging, metabolic syndrome, hypogonadism and prostate cancer treatment.[1–3] It has been estimated that, as the population ages, the worldwide prevalence of ED will double, from ~152 million men in 1995 to well over 300 million men by 2025.[4] Although several medical treatment options exist, dissatisfaction can be high,[5–10] with substantial dropout rates for these therapies.[11]

The surgical management of dysfunctional erections has been pursued for over 70 years, with the first penile implant consisting of autologous rib cartilage in a reconstructed neophallus credited to the Russian surgeon Bogoraz.[12] Prostheses consisting of foreign material were first implanted intracavernosally in 1966, and the first inflatable penile prosthesis (IPP) was employed in 1973.[13] Today, the most commonly used devices are 3-piece IPPs.

Much of what is known about modern IPPs has been derived from single- or multi-center retrospective studies, reporting the surgical experience of a select few experts in the field of sexual medicine. A PubMed search of 'inflatable penile prosthesis' in August 2012 reveals over 450 publications, of which a vast majority is of these types. Although efforts have been made to assess penile prosthesis utilization at the national level, these have been limited to total number of prostheses implanted, with analysis of issues, which may influence the use of such prostheses lacking.[14]

The purpose of this study is to report on the utilization of virgin penile prosthesis implantation for the management of ED and factors that impact this utilization. Two population sources were employed: data collected from Commercial and Medicare insurance claim databases, and a database derived from a single academic institution. The national claim databases, in particular, provide a unique perspective on the course of management for patients with ED and, to our knowledge, have not been previously investigated.