Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database |
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| Institution: | 1. Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA;2. Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, IL, USA;3. Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA;4. Department of Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA;1. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Urology, University of California San Francisco, San Francisco, CA, USA;1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA;2. Women''s Health Research Program, School of Public Health and Preventive Medicine, Monash University Melbourne, VIC, Australia;3. Department of Medicine, Weill Medical College, Cornell University, New York, NY, USA;4. Department of Medicine, George Washington University School of Medicine and Health Sciences, and IntimMedicine Specialists, Washington, DC, USA;5. Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, IT, USA;1. Urology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria, Madrid, Spain;2. Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel;3. Department of Experimental and Clinical Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy;4. Department of Urology, Biruni University School of Medicine, Istambul, Turkey;5. The Christie NHS Foundation Trust, Manchester, UK;6. Andrology Department, University College, London, UK;7. Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA;8. Flare-Health, Amstelveen, The Netherlands;9. Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy;10. Urology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain;1. Department of Urology, University of Rochester Medical Center, Rochester, NY, USA;2. Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA;3. Department of Urology, University College London Hospitals, London, UK;4. Department of Urology, Jessa Hospital Hasselt, Hasselt, Belgium;5. Department of Urology, Boston University, Boston, MA, USA;1. Department of Urology, Mayo Clinic, Rochester, MN, USA;2. Department of Urology, University of Colorado School of Medicine, Aurora, CO, USA;3. Department of Urology, Rush Medical College, Chicago, IL, USA;4. Department of Urology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA;1. School of Psychology, University of Ottawa, Ottawa, ON, Canada;2. Department of Psychology, University of Montreal, Montreal, QC, Canada;3. Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada;4. Departments of Psychology & Neuroscience and Obstetrics & Gynaecology, Dalhousie University, Halifax, NS, Canada |
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| Abstract: | BackgroundMany patients with erectile dysfunction (ED) after radical prostatectomy (RP) improve with conservative therapy but some do not; penile prosthesis implantation rates have been sparsely reported, and have used nonrepresentative data sets.AimTo characterize rates and timing of penile prosthesis implantation after RP and to identify predictors of implantation using a more representative data set.MethodsThe Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery databases for Florida from 2006 to 2015 were used. Patients undergoing RP (2006–2012) were tracked longitudinally for penile prosthesis implantation. Patient and clinical data were analyzed using multivariable logistic regression.OutcomesThe primary outcome was risk-adjusted predictors of prosthesis implantation, and the secondary outcome was predictors of the highest quartile of time between RP and penile prosthesis.ResultsOf 29,288 men who had RP, 1,449 (4.9%) patients underwent subsequent prosthesis. The mean time from RP to prosthesis was 2.6 years (median: 2.1; interquartile range IQR]: 1.2–3.5). Adjusted predictors of prosthesis implantation included open RP (odds ratio OR]: 1.5, P < .01), African American race (OR: 1.7, P < .01) or Hispanic ethnicity (OR: 3.2, P < .01), and Medicare (OR: 1.4, P < .01) insurance. Oler patients (age >70 years; OR: 0.7, P < .01) and those from the highest income quartile relative to the lowest (OR: 0.8, P < .05) were less likely to be implanted. Adjusted predictors of longer RP-to-implantation time (highest quartile: median: 4.7 years; IQR: 3.9–6.0 years) included open RP (OR: 1.78, P < .01), laparoscopic RP (OR: 4.67, P < .01), Medicaid (OR: 3.03, P < .05), private insurance (OR: 2.57, P < .01), and being in the highest income quartile (OR: 2.52, P < .01).Clinical ImplicationsThese findings suggest ED treatment healthcare disparities meriting further investigation; upfront counseling on all ED treatment modalities and close monitoring for conservative treatment failure may reduce lost quality of life years.Strengths & LimitationsThis study is limited by its use of administrative data, which relies on accurate coding and lacks data on ED questionnaires/prior treatments, patient-level cost, and oncologic outcomes. Quartile-based analysis of income and time between RP and prosthesis limits the conclusions that can be drawn.ConclusionLess than 5% of post-RP patients undergo penile prosthesis implantation, with open RP, Medicare, African American race, and Hispanic ethnicity predicting post-RP implantation; living in the wealthiest residential areas predicts lower likelihood of implantation compared to the least wealthy areas. Patients with the longest time between RP and prosthesis are more likely to live in the wealthiest areas or have undergone open/laparoscopic RP relative to robotic RP.Bajic P, Patel PM, Nelson MH, et al. Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database. J Sex Med 2020;17:1175–1181. |
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| Keywords: | Erectile Dysfunction Penile Prosthesis Prostate Cancer Prostatectomy Survivorship Disparities |
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