title: National practice patterns of treatment of erectile dysfunction with penile prosthesis implantation.
abstract: OBJECTIVE
  The increase in medical options to manage erectile dysfunction has changed how urologists approach erectile dysfunction. We reviewed contemporary trends in penile prosthesis implantation in the United States with an emphasis on practice patterns, demographics and temporal changes.
  
  
  METHODS
  Annualized case log data of penile prosthesis surgeries from certifying and recertifying urologists from 2003 to 2012 were obtained from the American Board of Urology. CPT code 54400 was used to identify malleable prosthesis surgeries and CPT codes 54401 and 54405 were used to identify inflatable prosthesis surgeries. To evaluate the association between surgeon characteristics and practice patterns we used the chi-square test.
  
  
  RESULTS
  The surgical cohort included 6,615 urologists who placed a total of 9,558 penile prostheses during the study period. Only 23.9% of urologists reported performing a penile prosthesis operation. Of the prostheses 75% were placed by surgeons who completed 4 or fewer such operations per year. Of urologists who recorded logs 1.5% considered themselves to be specialists in andrology and yet they were responsible for a disproportionate 10% of all prostheses implanted (OR 5.9, p <0.0001). The proportion of inflatable penile prostheses compared to malleable prostheses increased twelvefold in 10 years. The number of logged prosthesis surgeries was skewed toward more implants placed by the most experienced urologists than by new urologists (OR 1.92, p <0.0001).
  
  
  CONCLUSIONS
  Although specialists and high volume surgeons perform a disproportionate number of implant surgeries, low volume surgeons place most penile prostheses in the United States. Additional research is needed to determine best practices to achieve optimal patient outcomes in penile prosthesis surgery.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Oberlin
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Matulewicz
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Laurie
authors.initials: L
authors.lastname: Bachrach
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Hofer
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Brannigan
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: sflury@gmail.com.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Flury
mesh_terms: D007172:Erectile Dysfunction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation; D010818:Practice Patterns, Physicians'; D014481:United States; D014572:Urology
keywords: erectile dysfunction; outcome assessment (health care); penile implantation; penis; physician's practice patterns