Reoperation Rates for Penile Prosthetic Surgery

IntroductionIn patients with erectile dysfunction refractory to medical treatment, placement of a penile prosthesis is an effective treatment option. Despite advancements in prosthetic design, it is not without complications requiring reoperation.AimTo evaluate the long-term reoperation rate of penile prosthesis implantation.MethodsA longitudinal analysis of the California Office of Statewide Health Planning and Development database from 1995 to 2010 was performed. Inclusion criteria were men who underwent their first penile prosthetic surgery. Patients were excluded if they underwent explantation of a prior prosthesis at the time of their first recorded surgery. Statistical analysis was performed by Kaplan-Meier plot, hazard curve, and multivariate analysis adjusting for age, race, comorbidities, insurance status, hospital volume, and hospital teaching status.Main Outcome MeasuresPrimary outcome was reoperation, specified as the removal or replacement of the prosthesis.ResultsIn total, 7,666 patients (40,932 patient-years) were included in the study. The 5- and 10-year cumulative reoperation rates were 11.2% (CI = 10.5–12.0) and 15.7% (CI = 14.7–16.8), respectively. Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year postoperatively and steadily decreased until 2 years postoperatively. Multivariate analysis showed higher rates of reoperation in younger men (hazard ratio [HR] = 1.51, CI = 1.12–2.05), African-American men (HR = 1.30, CI = 1.05–1.62), and Hispanic men (HR = 1.32, CI = 1.12–1.57). Of the reoperations, 22.9% were performed at a hospital different from the initial implantation.ConclusionReoperation rate for penile prosthetic surgery is highest in the first year postoperatively. Patients with the highest risk for reoperation were African-American, Hispanic, and younger men. Nearly one fourth of reoperations occurred at a hospital different from the initial surgery, suggesting the existing literature does not reflect the true prevalence of penile prosthetic complications.