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Intraoperative and Postoperative Practice Patterns among Penile Prosthesis Surgeons
Ryan Frazier, M.D.1, Elia Abou Chawareb, M.D.2, Muhammed Hammad, MBBCh2, Stephen A. Harrington, M.D.3, Ambrose Orr, M.D.3, Benjamin Rosenfeld, M.D.3, Nicholas Moll, M.D.3, Samuel Ivan, M.D.4, Jay Simhan, M.D.4, Faysal Yafi, M.D.2, David Barham, M.D.1, Martin S. Gross, M.D.3.
1Brooke Army Medical Center, San Antonio, TX, USA, 2University of California, Irvine, Orange, CA, USA, 3Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 4Fox Chase Cancer Center, Philadelphia, PA, USA.
BACKGROUND: Penile prosthesis (PP) surgery has been an effective treatment for erectile dysfunction for over 50 years. It is presumed there are significant variations in intraoperative techniques and postoperative management among prosthetic urologists. We aim to evaluate the perioperative practice patterns of PP surgeons.
METHODS: An anonymous web-based survey was sent to members of SMSNA, SUPS, and GURS. Twenty-seven questions were asked regarding perioperative practice patterns of respondents. Descriptive statistics were performed.
RESULTS: 189 responses were received from prosthetic urologists. Most respondents (82.6%) were fellowship trained. 76.7% of respondents perform PP placement via penoscrotal approach compared to 23.3% infrapubic. Corporotomies were commonly closed with preplaced sutures compared to running closure (89.4% vs 9.5%) with PDS (43.9%) and Vicryl (36.5%) most frequently used (Table 1). 55.6% of respondents use a closed suction drain postoperatively, 45.2% of those leave a drain ≥2 days. Clinical data influenced 54.3% of respondents' drain duration with drain output the most common basis for duration (91.2%). Mummy wrap (73.5%) with scrotal support (78.8%) was the most common postoperative dressing. 56.1% of respondents leave a Foley postoperatively with 92.5% removing it on postoperative day one. Same day discharge is routinely performed by 61.4% while 23.3% prefer 23-hour observation. Most surgeons (65.6%) leave the device inflated; 51.6% inflating >50% and 44.4% <50%. There was significant variability in timing of first postoperative visit and initiating device cycling. 26.5% of surgeons clear the patient to use the implant at 4 weeks, 55.6% clear at 6 weeks.
CONCLUSIONS: Our results demonstrate wide variability in practice patterns for PP surgery. These results will guide future studies to understand the implications of these practices on patient outcomes and experiences.
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