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Abstract
INTRODUCTION AND OBJECTIVES: The true reoperation rate of penile prosthetic surgery is unknown due limited data from retrospective, single institution studies. This study aims to evaluate the reoperation rate after virgin penile prosthetic surgery using a large population database METHODS: A longitudinal analysis of California Office of Statewide Health Planning and Development database from 1995 to 2010 was performed. Inclusion criteria were men who underwent their first penile prosthetic surgery. Patients were excluded if they had an explant of a prior prosthesis at the time of their first recorded surgery. Primary outcome was reoperation, specified as the removal or replacement of the prosthesis. Censoring events included penile amputation, surgeries of the genitalia or pelvis, and cancer involving the genitourinary organs. Statistical analysis was performed via KaplanMeier plot, hazard curve, and multivariate analysis adjusting for age, race, gender, comorbidities, insurance status, hospital volume and teaching status RESULTS: 7,666 patients (40,932 patient years) were included in the study. The 5 and 10-year cumulative reoperation rates were 11.2% (CI: 10.5-12.0%) and 15.7% (CI: 14.7-16.8%) respectively. Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year post-operatively (3.4% per year), and steadily declined until 2 years post-operatively, after which it remained at roughly 1.25% per year. Multivariate analysis showed higher rates of reoperation among younger patients (HR1⁄41.51, CI: 1.122.05 for 75yo), African American patients (HR1⁄41.30, CI: 1.05-1.62), and Hispanic patients (HR1⁄41.32, CI: 1.121.57). 22.9% of the reoperations were performed at a hospital different from the initial implantation CONCLUSIONS: Reoperation rate for penile prosthetic surgery is highest in the first year postoperatively. The patients with highest risk for reoperation are African American, Hispanics, and younger age for unclear reasons that warrant further study. Nearly a quarter of reoperations occur at a hospital different from the initial surgery, suggesting that existing literature does not reflect the true prevalence of penile prosthetic complications
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