Global trends in prevalence, treatments, and costs of penile prosthesis for erectile dysfunction in men

Abstract

ABSTRACT Introduction Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery. Objective To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable vs inflatable prosthetic surgery, inpatient vs outpatient implantation surgery, the proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost. Methods A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs. Results Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. Trend analysis demonstrates that rates of penile prosthetic surgery dramatically declined in the late 1980s and early1990s but has demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Penile prostheses device costs have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the United States, with a more modest global growth. Conclusion Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries but surging inclusive surgical cost may present a barrier for some patients without insurance coverage. Disclosure Work supported by industry: no.