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Pattern of surgical care of patients with erectile dysfunction: pooled analysis from two prospective population-based registry

Capogrosso, P1Deho', F1; Jani, K2; Caraceni, E1; Karpman, E3; Pescatori, E1; Brant, W4; Palmieri, A1; Salonia, A1; Paradiso, M1; Colombo, F1; Carrino, M1; Henry, G2

1: Italian Society of Andrology - SIA, Italy; 2: Ark-La-Tex Urology, US; 3: l Camino Urology Medical Group, US; 4: Veterans Affairs, Salt Lake City Healthcare System, US

Objective: The clinical practice management of erectile dysfunction (ED) may differ across countries worldwide.We compared data on surgical and peri-operative management strategies of patients submitted to penile prosthesis implantation (PPI), from two prospective multicenter population-based registries.

Materials and Methods: Data were collected from the Italian multi-institutional, monitored and internal review board (IRB) approved registry on PPI (INSIST-ED) including data from 33 institutions. Similarly, data from the IRB-approved Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER), including data from 13 North American sites, were also collected. Both registries assess patient’s baseline characteristics, ED etiology, surgical and peri-operative management strategies. As a main aim of this study, a pooled data analysis was conducted to assess differences in surgical and peri-operative management strategies between the two registries; the Pearson’s Chi square test was applied.

Results: Data from 405(23.2%) patients from the INSIST-ED registry and 1340(76.8%) from the PROPPER study were analysed. Overall, 95.3%(1663) of patients received a three-component hydraulic prostheses (AMS 700); a higher percentage of two-component (AMS Ambicor) and malleable prostheses (AMS Spectra) were implanted in the INSIST-ED registry compared to the PROPPER study [24(5.9%) and 13(3.2%) vs 29(2.2%) and 13 (1%); p<0.001]. Although the penoscrotal approach was the most frequently applied overall [79.4%(1386)], a higher number of procedures were conducted with an infrapubic approach in the PROPPER study compared to the Italian registry [284(21.2%) vs 65(16%); p<0.001]. A larger number of patients in the PROPPER registry received a mummy-wrap dressing after surgery compared to the INSIST-ED registry [1314(98.1%) vs 97(24%); p<0.001]; moreover, a surgical drain was placed in a higher number of cases in the INSIST-ED compared to the PROPPER [48.1%(195) vs 46.6%(625); p=0.03].

Conclusions: The three-component hydraulic model is currently the most common implanted prosthesis for the surgical treatment of ED in both Europe and North America. The highlighted differences in the peri-operative management between the two registries provide insights into the pattern of surgical care for ED in the real-world setting.

Disclosure:

Work supported by industry: yes, by AMS - Boston Scientific (industry funding only - investigator initiated and executed study).

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