Recipients of inflatable penile prostheses (IPPs) are less likely to need reoperation if their surgeons are “high volume implanters,” according to a study published last summer in the Journal of Urology.
Over 15,000 prostheses are implanted in the United States each year, the report noted. But complications, such as infection and device malfunction, do occur. These situations often require reoperation, which carries risk of further infection, urethral injury, and shortening of the penis.
Reoperation rates in light of surgeon experience has not been widely studied. For the current report, researchers looked at data from the Statewide Planning and Research Cooperative System (SPARCS) database, maintained by the New York State Department of Health. This database includes medical information recorded in all participating facilities in New York State.
The researchers focused on data collected between 1995 and 2014, paying close attention to reoperation, defined as the replacement, repair, or removal of the first penile prosthesis. They also looked at surgeon experience. High volume implanters performed more than 31 implant procedures each year.
They found that 14,969 “virgin” IPP procedures were conducted during this time period with an average follow up of 95.1 months. Overall, 6.4% of these procedures required reoperation – 2.5% for infection and 3.9% for noninfectious complications.
Reoperation rates based on surgeon experience were as follows:
|Annual implant case volume||Reoperation Rate|
|0 to 2 cases||8.5%|
|3 to 7 cases||7.4%|
|8 to 31 cases||5.0%|
|More than 31 cases||4.8%|
Patients of surgeons with lower annual implant volumes (31 cases or fewer) were more likely to need reoperation than those treated by high volume implanters. These patients were more likely to need reoperation due to infection, but no relationship was found between surgeon experience and noninfectious complications.
The study authors suggested that higher volume implanters may have more experienced assistants “who are presumably less likely to inadvertently contaminate an exposed device.” It’s also possible that these implanters are more likely to follow stricter protocols and complete procedures in shorter amounts of time, lowering the risk of infection.
Because the SPARCS database does not provide information beyond New York State or from non-SPARCS facilities, the true rates of reoperation are likely higher than reported. For example, the data would not reflect men who had their first implant in New York but their reoperation in another state or from a non-SPARCS hospital.
Information about the implant models and surgical techniques was also not available.
Further research “is critically important for understanding the long-term outcomes of penile prosthesis surgery,” the authors wrote.
The Journal of Urology
Onyeji, Ifeanyi C., et al.
“Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery”
(Full-text. Published online: August 18, 2016)