Ethnic Disparities in Penile Prosthesis Surgery: An Analysis of Hispanic Patients

Abstract

ABSTRACT Introduction Disparities in disease incidence and outcomes are common in sexual medicine including erectile dysfunction (ED). As limited studies evaluate how ethnic disparities affect the way ED is treated, we used data from a high-volume center to investigate differences between Hispanic and non-Hispanic men following 3-piece inflatable penile prosthesis surgery. Objective To investigate differences between Hispanic and non-Hispanic patients undergoing Penile Prosthesis Surgery. Methods We performed a retrospective cohort study of two high volume implanters using records and data collected prospectively. Patient characteristics, comorbidities, and surgical outcomes were compared. Ethnicity was identified as Hispanic, non-Hispanic white, African American, and other. All patients completed a Sexual Health Inventory for Men (SHIM) questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. We also employed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Visual Analog Scale (VAS) for Pain. Multivariate Analysis and logistic regression were used to identify the association between ethnicity, comorbidities, and surgical outcomes. Results 1,158 patients who underwent penile prosthesis surgery from April 2018 to June 2021, were evaluated. Most study participants were Hispanic (68.2%), with non-Hispanic whites counting for 22.5% of population followed by African Americans (8.6%) and other ethnicities (<1%). Hispanics were found to have penile prosthesis surgery at a younger mean age (58.6 vs 64.3 years) when compared to NHW. Overall Hispanics were found to have a greater incidence of comorbidities such as diabetes mellitus (DM), and vascular disease. The most common patient comorbidities among Hispanics were DM (34.2% v 27% NHW), cardiovascular disease (CVD) (20.2% v 18.1% NHW), and Peyronie's disease (12.4% vs 10.2% NHW). Primary etiology of ED among Hispanics was found to be DM (32.3%), CVD (24.1%), Radical Prostatectomy (12.4%), Peyronie's disease (5.3%), priapism (3.3%) and others (22.6%). Pain scores prior to discharge on POD #1 were a mean of 3.2 (median 3, range 0-6) in Hispanics vs 4.1in NHW (median 4, range 0-8). At POD #10, scores for the Hispanic cohort were a mean of 0.53 (median 0, range 0-2) versus a mean of 0.73 (median 0, range 0-2). Hispanic men rate satisfaction with their IPP very high when compared to NHW, (94% vs 89%) according to validated testing. Conclusions Despite younger age of disease progression at time of surgery, Hispanic ethnicity was an independent predictor of higher satisfaction rates and lower pain scores. Conversely Hispanics were found to suffer from more incidence of comorbidities when compared to NHW. This study suggests there may be disparities in disease progression and surgical outcomes between Hispanics and non-Hispanic whites. Further work is necessary to confirm this health disparity in other large datasets. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific