Genitourinary Prosthetic Use Among Prostate Cancer Survivors Treated with Radical Prostatectomy

Abstract

ObjectiveErectile dysfunction and urinary incontinence are well-known side effects of radical prostatectomy that, when refractory to medical therapy, can be addressed by major genitourinary prosthetic surgery (urethral slings, artificial urinary sphincters (AUS), penile prostheses (PP)). Though these procedures have been evaluated in single institution studies, population-based analyses regarding their utilization have been sporadic. Thus, we sought to characterize post-prostatectomy genitourinary prosthetic surgery in a contemporary, population-based cohort of men with private insurance. Material and MethodsUsing MarketScan Commercial Claims data, we identified men undergoing RP between 2009-2010 based on coding. Our primary outcome was receipt of genitourinary prosthetic device based on codes documented in claims from 2009 through 2015. Other factors of interest included patient age, comorbidity, and geographic region. ResultsWe identified 23,813 men who underwent radical prostatectomy in 2009 and 2010 (mean age (SD) = 55.5 years (9.1)). Overall, 731 men (3.07%) underwent genitourinary prosthetic surgery, including 243 (1.0%) male slings, 111 (0.5%) AUS, and 377 (1.6%) PP. Median time to the first prosthetic surgery was 21.7 months (SD 12.9; range = 1.2-54.5). Men undergoing prosthetic surgery for post-prostatectomy complications were older (57.1 vs. 55.5y, p=0.001), and more likely to be diabetic (31.9 vs. 22.6%, p<0.001) than the remainder of the cohort. There was no significant difference in receipt of surgery based on overall comorbidity or geographic region (all p>0.05). ConclusionsOverall, receipt of genitourinary prosthetic surgery for incontinence (1.5%) or erectile dysfunction (1.6%) was rare following radical prostatectomy. However, diabetic and older men demonstrated a greater likelihood of device placement.