Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA.
J Sex Med. 2020 Nov;17(11):2287-2290. doi: 10.1016/j.jsxm.2020.07.082. Epub 2020 Aug 31.
Implantation of an inflatable penile prosthesis (IPP) has high success and satisfaction rates, but there remains a paucity of evidence examining non-usage of IPP and reasons for discontinuation.
To identify how frequent patients use their prosthesis and their personal reasons for no longer using it.
We conducted a survey of all patients who underwent an IPP implantation by a single surgeon over a 6-year period, between 2012 and 2018. After application of inclusion and exclusion criteria, a total of 114 patients formed the final cohort. Patients were initially surveyed via mail with a questionnaire; those who did not respond were surveyed via telephone. The factors determining patient selection for IPP implantation included suitability for general anesthesia, manual dexterity to use the device by the patient or their partner on a demonstration device, and presence of refractory erectile dysfunction, HbA1C lower than 8.5, or need for a revision of a previously placed IPP. Universally, a 3-piece AMS 700 Series implant was placed via the penoscrotal approach. Data were analyzed with Pearson chi square test, and survivability of the device was assessed with Kaplan-Meier survival curve.
The main outcomes of this study are the frequency of IPP usage and reasons for discontinuation.
The survey participation rate was 97%. The mean age of patient was 64 years (range 34-83 years), and the mean time between surgery and completion of survey was 2.98 years (range 0.25-7.4 years). Kaplan-Meier curve demonstrated that 68% of the patients were using the IPP at 5 years after implantation. Using the age 70 years as a cutoff, 18 (22%) patients younger than 70 years and 14 (42%) patients older than 70 years discontinued using the IPP (P = .029). The commonest reasons for discontinuation were poor health to engage in sexual activity (2.6%), loss of companion (19%), loss of interest in sex (2.6%), and device malfunction with no further interest in revision of prosthesis (14%).
The clinical implication of this study was improved patient selection for device implantation.
To our knowledge, no other study has investigated reasons for patients no longer using their prosthesis. Our study has several limitations including that it is a cross-sectional analysis, our survey is not validated, this is a single-surgeon experience, we have a small sample size, and we did not differentiate between virgin implant and reimplantation.
Our study shows a high rate (28%) of non-usage of IPP, more so in men older than the age of 70 years in the first 5 years of implantation. Knoll P, Rai S, Talluri S, et al. A Survey of Usage of Penile Prosthesis. J Sex Med 2020;17:2287-2290.
阴茎可膨胀假体（IPP）的植入具有较高的成功率和满意度，但仍缺乏对 IPP 未使用情况和停用原因的证据。
确定患者使用假体的频率及其不再使用假体的个人原因。
我们对 2012 年至 2018 年间由一位外科医生植入的所有 IPP 患者进行了调查。应用纳入和排除标准后，共有 114 名患者进入最终队列。患者最初通过邮件进行问卷调查；未回复的患者通过电话进行调查。决定患者选择植入 IPP 的因素包括是否适合全身麻醉、患者或其伴侣在演示设备上使用该设备的手巧程度，以及是否存在难治性勃起功能障碍、HbA1C 低于 8.5 或需要修复先前放置的 IPP。普遍情况下，通过阴茎阴囊入路植入 3 件 AMS 700 系列植入物。使用 Pearson 卡方检验进行数据分析，使用 Kaplan-Meier 生存曲线评估设备的存活率。
本研究的主要结果是 IPP 使用频率和停用原因。
调查参与率为 97%。患者的平均年龄为 64 岁（34-83 岁），手术与完成调查之间的平均时间为 2.98 年（0.25-7.4 年）。Kaplan-Meier 曲线显示，植入后 5 年时，68%的患者仍在使用 IPP。以 70 岁为截止年龄，70 岁以下的 18 名（22%）患者和 70 岁以上的 14 名（42%）患者停止使用 IPP（P=.029）。停用的常见原因是健康状况不佳而无法进行性行为（2.6%）、失去伴侣（19%）、对性失去兴趣（2.6%）以及设备故障且对修复假体不再感兴趣（14%）。
本研究表明，对设备植入进行了改进的患者选择。
据我们所知，没有其他研究调查过患者不再使用假体的原因。我们的研究有几个局限性，包括这是一个横断面分析，我们的调查未经验证，这是一位外科医生的经验，我们的样本量较小，我们没有区分初次植入和再次植入。
Knoll P, Rai S, Talluri S, et al. A Survey of Usage of Penile Prosthesis. J Sex Med 2020;17:2287-2290.
