Worldwide Trends in Penile Implantation Surgery

Data From Over 63,000 Implants

Wesley Baas; Blake O'Connor; Charles Welliver; Peter J. Stahl; Doron S. Stember; Steven K. Wilson; Tobias S. Köhler

Disclosures

Transl Androl Urol. 2020;9(1):31-37. 

In This Article

Abstract and Introduction

Abstract

Background: Penile prosthesis implantation represents the gold standard of treatment for severe or medically refractory erectile dysfunction (ED). We sought to address the paucity of currently available literature about global penile prosthesis usage in regard to geography, patient age, surgical approach, implanter volume, and etiology of ED.

Methods: From device manufacturer information, we compiled data on over 63,000 implants performed worldwide. Data was grouped and then analyzed to examine trends in penile implantation between the years of 2005–2012.

Results: The number of implants was seen to steadily increase over the study period. Of the 63,013 total procedures recorded, 85.9% were performed within the United States. 60–78% of procedures were done using the penoscrotal (PS) approach, with only Belgium/Netherlands as an outlier with an infrapubic (INF) majority. The US was notable for having an increasing number of implanters doing 16–30, 31–50, or >100 implants yearly. Etiology of ED worldwide was variable, but "organic," post-prostatectomy, and diabetes accounted for the vast majority of cases worldwide.

Conclusions: Penile prosthesis implantation is an increasing practice, as evidenced by a steady increase in the number of implants performed over a 7-year study period. Acceptance of this treatment option for ED is variable by region with the US leading the annual number of implantations by a wide margin. Worldwide, there appears to be a predominance of surgeons placing implants via the PS approach.

Introduction

Penile prostheses remain the gold standard of treatment for severe or medically refractory erectile dysfunction (ED). Reliable, on-demand erections, along with an ever-improving mechanical lifespan has led to high satisfaction rates.[1–5] There have been numerous advances in the field of penile prosthetics, with the first three-piece inflatable device being introduced in 1973.[6]

The last decade has brought several advances in penile prosthesis design and technique. Enhancements in reservoir design, cylinder characteristics, and the widespread use of infection retardant coatings have made devices safer for patients and possibly easier for implanters to place.[7,8] Despite these advances, only a small percentage of men who would benefit from penile prostheses elect to undergo surgery.[9] While a wide variety of both patient and physician factors may influence worldwide trends in prosthesis implantation, these trends and significant factors are largely uncharacterized.

In this study, we use two large databases to review modern trends of global penile prosthesis usage in regard to geography, patient age, surgical approach, implanter volume, and etiology of ED.

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