Contemporary use of non-hydraulic penile prosthesis in patients with erectile dysfunction: data from the national prospective registry of penile prosthesis implantation “INSIST-ED”
Capogrosso, P1; Pescatori, E1; Cazzaniga, W1; Vitarelli, A1; Vicini, P1; Palumbo, F1; Falcone, M1; De luca, F1; Matera, M1; Natali, A1; Tamai, A1; Garaffa, G1; Salonia, A1; Palmieri, A1; Dehò, F1
1: Societa' Italiana di Andrologia, Rome, Italy
Objective: We looked at the contemporary use of either hydraulic or non-hydraulic models in a prospective national registry of penile prosthesis implantation (PPI), with the aim to identify the profile of patients more likely to be offered with a malleable prosthesis in clinical practice.
Materials and Methods: Data from a national multi-institutional database of PPI including patients treated from 2014 to 2017 in Italy (INSIST-ED) were analyzed. Data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single datamanager. The characteristics of patients offered with either a non-hydraulic or a hydraulic (either bi-component or tri-component) model were compared with the Mann-Whitney and Fisher’s exact tests. Logistic regression analyses tested the association of clinical variables and the type of prosthesis received. Restricted cubic splines with knots at the tertiles tested for non-linearity between continuous variables and the investigated outcome.
Results: Complete data were available for 643 patients; median (IQR) age was 60 (56-67) years. Overall, 119 (19%) patients were offered with a non-hydraulic implant, whereas 23 (3.6%) and 501 (78%) received a bi- and a tri-component prosthesis, respectively. Malleable prostheses were more frequently offered to patients with penile curvature [39% (46)] and vasculogenic ED [45% (53)]; post-pelvic surgery ED was the most common etiology among patients implanted with an hydraulic model [45% (235)] (p<0.001). Moreover, 32.6% (47) of patients treated in private hospitals were offered a non-hydraulic model compared to 14.4% (72) of those treated in public centers (p<0.001). At multivariable logistic regression analysis, men with vasculogenic ED, those with penile curvature and those treated in a private center were more likely to be offered with a malleable prosthesis (all p<0.004). A non-linear association was found between age and a non-hydraulic implants (p<0.001), with the probability of receiving a malleable prosthesis decreasing from 20 to 60 years of age and then significantly increasing after 60.
Conclusions: Data from a national registry show that roughly 20% of patients are currently implanted with malleable prosthesis in the real-life clinical practice. Physicians are more likely to offer a non-hydraulic model to very young or old patients with either penile curvature or vasculogenic ED
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