(047) Practice Patterns for Inflatable Penile Prosthesis Revisions Within a Large Fully Integrated Healthcare System

Abstract

Abstract Introduction Revision Inflatable Penile Prosthesis (IPP) surgery is considered to be more surgically complex than virgin IPP implantation. Not all implanters perform revision surgery. Moreover, there is a paucity of data on the practice patterns of implanters regarding revision surgery. We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system. Objective We aimed to evaluate the practice patterns of revision vs virgin inflatable penile prosthesis implantation within a large fully integrated healthcare system. Methods After Institutional Review Board approval, we reviewed the Kaiser Permanente Southern California (KPSC) database for all IPPs implanted within a 10 year period (2009-2019) at 15 medical centers. Patients undergoing virgin and revision penile prosthetic surgery were identified using CPT codes. Preoperative patient characteristics, intra-operative and postoperative outcomes were obtained via retrospective chart review. Univariate and multi-variate logistic regressions were performed. Results Between 2009 and 2019, 1,093 IPP surgeries were performed at KPSC, 115 of which were revision cases (10.5%). A total of 66 surgeons performed at least 1 IPP surgery (median=5 IPPs/surgeon, Range 1-160). Yet, revision IPPs were performed by only 32 surgeons, of which 4 surgeons were responsible for 61 of the revisions (p<0.05). When compared to virgin cases, revision cases had a longer median operative time (121 mins vs 96 mins, p <0.001), were more likely to be a penoscrotal approach (OR 3.17, p<0.05), have an ectopic reservoir placement (63.5% vs 35.7%, p<0.001), and significantly less likely to have a concurrent procedure done (OR 0.21, p<0.05) all based on multivariable logistic regression analysis. Nevertheless, device infection rates were not significantly different (revision 2.6% vs virgin 4.5%, p=0.43). There was no difference in intra-operative complications between revision and virgin cases (2.6% vs 1.4%, P=0.5). Median follow up was 4.1 years. Conclusions To our knowledge, this is one the largest series of revision IPPs done at multiple centers among more than 30 surgeons with long term follow up. Our data suggests that most IPP revisions are done by a select few implanters. Despite longer operative times, device infection rates were less than virgin cases, though not statistically significant. Within our large fully integrated healthcare system, in the hands of high-volume revision implanters, device infection and intraoperative complications rates remain quite low. These findings could help implanters counsel future patients regarding revision IPP surgery. Disclosure No.