Trends in the placement of penile prostheses over the last 17 years in France.

Abstract

Dear Editor, Erectile dysfunction (ED) currently affects 152 million men worldwide and this number is likely to reach 322 million by 2025.1 Penile prostheses (PP) placement remains a last-resort option in cases where organic ED has not been cured by previous medications, notably intracavernosal injection and oral phosphodiesterase type-5 inhibitor.2 France ended 2013 with a population of 66 million inhabitants. In our study, we obtained data through the French national code registry database programme de médicalisation des systèmes d’information and from the patient-information forms filled out by the surgeon at the time of the implant. For claim purposes, this system comprehensively records information concerning every surgical procedure that is performed in a private or public hospital in France. Data were extracted for all patients who had undergone a penile implantation between 1997 and 2013. Overall, 6982 PP were inserted over the last 17 years in France. We found that 2821 PP were implanted in France between 1997 and 2005 (i.e. mean number of 352.6 PP per year), and 4161 PP between 2006 and 2013 (i.e. the mean number of 594.4 PP per year) (Figure 1). Although the number of PP placements has increased considerably over this period, PP appears to be still underutilized in France compared with the USA, where they are used to treat ~ 10% of impotent men.3 In addition, in the future, even more men are likely to develop ED associated with diabetes or other comorbidities, such as metabolic syndrome.Figure 1: Trends in penile prosthesis implantation between 1997 and 2013 in France.Overall, we found that 1182 revisions (16.9%) and 2264 explanations (32.4%) of PP occurred over the 17 years period (Table 1). PP implantation can require later revisions or even removal due to complications (i.e. infections or mechanical issues). In the literature, the main complication was infection, which developed in 1.7%–6.6% of cases.4 In the largest French previous series, of 282 PP, sepsis occurred in 2.2% of cases, 5.6% of cases had mechanical dysfunction, and 9.3% of cases were in the iterative poses.5 Wilson et al.6 estimated that only 60% of first PP implants would survive for >15 years without revision or extraction. PP is efficacious in most men and have a satisfaction rate of 81% compared with 51% with sildenafil and 40% with intracavernosal injections.45678Table 1: Trends in the numbers of PP devices implanted, the need for revision, and the explanation procedures used in France since 1997As yet, PP is only implanted, in France, in a limited number of tertiary referent centers. It would be of benefit if these centers communicated with general practitioners and the general population on this successful therapeutic approach. In the light of current data, PP may be underused in France because medical personnel and the general population have little information on this therapy. Finally, PP is really an expensive procedure, and cost can become an issue in many countries since few patients have the ability to afford the price of the device. However, the cost is not an issue in France as the health care system refund patients who require a PP, notably those who have diabetes and prostate cancer. Indeed, public hospitals do buy prostheses. The possibility of PP placement may depend on factors-related to catchment areas, patient recruitment, management, and strong differences in health care systems from country to another in the western world. Thus, we have no data to make a direct comparison between countries, and it is difficult to know whether these considerations can be translated in other countries. AUTHOR CONTRIBUTIONS PL and TS extracted national data. PL and PM wrote the manuscript. SB was involved in the critical revision of the manuscript. MR was a senior author and initiated the conception and the draft of this letter. COMPETING INTERESTS The authors declare that they have no competing interests.