[Evolution of the number and type of penile prostheses implanted in France for erectile dysfunction: Analysis of French national coding database (2006-2013)]

Penile prosthesis for erectile dysfunction in France: A six-year nationwide database analysis

INTRODUCTION

Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016.

OBJECTIVES

This study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI).

MATERIALS AND METHODS

We analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded.

RESULTS

During the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1-2% of the patients were rehospitalized.

CONCLUSION

PP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021.

LEVEL OF EVIDENCE

4: Descriptive epidemiological study.

Dynamism of andrological surgery in France: Evolution of procedures over 10 years

INTRODUCTION

Andrology and urogenital reconstruction are emerging disciplines in French urology. The aim of our study was to evaluate the evolution of andrological surgical procedures over the period 2013-2022 using national data.

MATERIALS AND METHODS

We collected national common classification of medical acts (CCAM) coding data for all procedures involving andrological surgery from the Scansanté internet platform set up by the Technical Agency for Information on Hospitalisation, which collects prospectively from healthcare structures all procedures coded according to CCAM coding. All surgical procedures in andrology were selected. The inclusion period extended from 2013 to 2022.

RESULTS

In 10 years, the number of vasectomies has increased tenfold, with 29,890 cases in 2022. Vaso-vasostomies remain marginal, with 80 cases per year. Trans-identity surgeries are rising sharply. Vaginoplasties have multiplied by 4 (333 in 2022) and masculinising surgeries have multiplied by 10 (234 in 2022). Penile prosthesis surgery has increased slightly over 10 years. The number of testicular biopsies has remained stable over time, as has the number of surgeries for curvature of the penis.

CONCLUSION

Two andrological surgeries are showing very strong growth: vasectomy and transgender surgery. The emergence of these 2 activities is linked to societal aspirations. Urologists need to be trained to meet this demand.

NIVEAU DE PREUVE

Grade 4.

Long-term outcomes after penile prosthesis placement for the Management of Erectile Dysfunction: a single-Centre experience

Background

Penile prothesis (PP) is the gold-standard treatment of drug-refractory erectile dysfunction (ED). While postoperative outcomes have been widely described in the literature, there are few data about patient satisfaction and intraoperative events. We aimed to assess long-term patient satisfaction and perioperative outcomes after PP implantation in a single-centre cohort of unselected patients using validated scales.

Results

A total of 130 patients received a PP (median age: 62.5 years [IQR: 58–69]; median International Index of Erectile Function (IEEF-5) score: 6 [IQR: 5–7]). Median follow-up was 6.3 years [IQR: 4–9.4]. Thirty-two (24.6%) patients underwent surgical revision, of which 20 were PP removals (15.4%). Global PP survival rate was 84.6% and previous PP placement was a risk factor for PP removal (p = 0.02). There were six (4.6%) non-life-threatening intraoperative events including two which resulted in non-placement of a PP (1.5%). EAUiaic grade was 0 for 124 procedures (95.4%), 1 for four procedures (3.1%) and 2 for two procedures (1.5%). Of patients who still had their PP at the end of the study, 91 (80.5%) expressed satisfaction.

Conclusions

PP implantation is a last-resort treatment for ED with a satisfactory outcome. PPs are well accepted by patients.

Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice

Objectives:

This study aimed to define contemporary perioperative management of patients undergoing penile implant surgery in the UK.

Methods:

All consultant urological surgeons responsible for the insertion of penile prostheses in the UK were invited to complete an online survey comprising of 25 questions relating to surgeon demographics, patient selection, preoperative work-up, intraoperative management and postoperative care. Anonymised responses underwent descriptive statistical analysis, with particular focus on measures employed to reduce the risk of perioperative infection.

Results:

Of the 34 invited surgeons, 26 (76.5%) responded to the survey. The majority reported undertaking between 10 and 30 cases in 2018 ( n=17; 65.4%). A total of 23 (88.5%) respondents reported employing a threshold for diabetic control, although the exact limit varied between surgeons. Most respondents ( n=22; 84.6%) reported routinely sampling urine for microscopy, culture and sensitivity. All but one ( n=25; 96.2%) reported routinely performing cavernosal washouts, with the most common solution being a mixture of gentamicin and vancomycin (42.3%). All reported routinely giving intravenous antibiotics on induction of anaesthesia, and although there was no clear consensus, most surgeons preferentially used an aminoglycoside in combination with one other agent (including penicillins or teicoplanin).

Conclusion:

The variation in current perioperative management demonstrates a potential need for the development and introduction of evidence-based guidelines to standardise practice nationwide. Level of evidence: 5

[Sexual consequences after treatment of prostate cancer: Inquiry among members of the Association Nationale des Malades du Cancer de la Prostate]

INTRODUCTION

Complications of prostate cancer treatments are responsible of a lower quality of life. We evaluated the prevalence and the perceptions of sexual consequences of prostate cancer treatments.

MATERIALS AND METHODS

A retrospective self-administered questionnaire was sent to all the members of the Association Nationale des Malades du Cancer de la Prostate (ANAMACAP). All the answers were analyzed.

RESULTS

226 questionnaires were analyzed, the average age was 67.3 years old, the average follow-up was 58.1 months. 110 patients had surgery only, 29 had hormone therapy plus radiotherapy, 28 had radiation therapy only and 49 had combined treatments. After the treatment of the prostate cancer, an erectile dysfunction was reported by 75.2% of the patients; an orgasmic dysfunction by 69%; a climacturia by 21%; a reduced penile length by 70% of them and a less sensitive glans by 59%. They were responsible of a lower quality of life for 75% to 90% of the patients depending on the symptom. A PDE5-inhibitor treatment was effective for only 25.6% of them when taken daily and for 39% on demand.

CONCLUSION

Functional consequences of prostate cancer treatments are common, diverse and directly involved in the sexual life. It is necessary to improve therapeutical education and onco-sexology with the help of patients' associations, to build a new balance in the couples.

LEVEL OF EVIDENCE

3.