title: Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey.
abstract: Inflatable penile prostheses (IPPs) are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume. A written questionnaire was distributed to 1968 urologists. Responses were collated and analyzed. Respondents were defined as high volume implanters (HVIs) if they placed >or=20 IPPs in the year preceding the survey, or low volume implanters (LVIs) if they placed <or=19. Our main outcome measures were surgeon volume, approach to initial IPP placement (penoscrotal vs infrapubic), strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only. HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. There are significant differences in the self-reported practice patterns of HVIs and LVIs. The importance of these differences for patient outcomes remains undefined.
authors.affiliation: Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. akramer@smail.umaryland.edu
authors.forename: A C
authors.initials: AC
authors.lastname: Kramer
authors.forename: J
authors.initials: J
authors.lastname: Sausville
authors.forename: A
authors.initials: A
authors.lastname: Schweber
mesh_terms: D006801:Humans; D008297:Male; D019935:Penile Implantation / Q000379:methods* / Q000706:statistics & numerical data*; D015917:Penile Prosthesis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome