318 Pattern of Surgical Care of Patients with Erectile Dysfunction: Pooled Analysis from two Prospective Population-based Registry

Abstract

To compare data on surgical and peri-operative management strategies of patients submitted to penile prosthesis implantation (PPI), from two prospective multicenter population-based registries. 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 11 North American sites, were also collected. Both registries assess patient's baseline characteristics, erectile dysfunction (ED) etiology, surgical and peri-operative management strategies. As a primary outcome 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. Data from 405(23.2%) patients from the INSIST-ED registry and 1340(76.8%) from the PROPPER study were analyzed. 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]; interestingly, the subcoronal approach was infrequently adopted, with only 1.5%(6) and 0%(0) of cases performed with this technique in the INSIST-ED and PROPPER study. At the end of the procedure, a larger number of patients received a mummy-wrap dressing in the PROPPER study 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 Italian registry compared to the PROPPER [48.1%(195) vs 46.6%(625); p=0.032].