The future of penile prosthetic surgery in the UK

Abstract

Introduction: The provision of penile prosthetic surgery (PPS) in the United Kingdom needs to be reviewed given the twin popular philosophies of Centres of Excellence, as defined by high case volume yielding best outcomes, and Getting It Right First Time (GIRFT), defined as effective and efficient use of resources. Methods: To recognise centres of high volume of PPS and their location, we interrogated Hospital Episode Statistic (HES) data between 2014 and 2017. From this analysis we advance a model of the 10 British Association of Urological Surgeons (BAUS) regions in England providing PPS, working largely to recommendations made by National Health Service (NHS) England through its Clinical Commissioning Policy for Penile Prosthesis. Results: Between 2014 and 2017, there were 2361 surgical procedures undertaken, and of these, primary implantations numbered 1330 and revisions 1031. University College London Hospitals performed more than 50% of all primary implantations and 52% of all revisions. Across England for the year 2017, there were 301 primary implantations and 442 revisions. Discussion: We suggest that revision surgery for device mechanical failure should be within the remit of these centres but referral of complex revision surgery irrespective of aetiology may warrant referral to defined tertiary centres in London, the Midlands and the North of England. Conclusion: Prospective data on patient outcomes from PPS are urgently needed, and NHS England should regard a national database of PPS as essential. We advance a model of the 10 BAUS regions in England providing PPS as a distributed and geographically equitable network for primary implantation. A regionalised network of revision surgery should be considered. Level of evidence: Not applicable for this multicentre audit.