title: Reoperation Rates for Penile Prosthetic Surgery.
abstract: BACKGROUND
  In patients with erectile dysfunction refractory to medical treatment, placement of a penile prosthesis is an effective treatment option. Despite advancements in prosthetic design, it is not without complications requiring reoperation.
  
  
  OBJECTIVE
  To evaluate the long-term reoperation rate of penile prosthesis implantation.
  
  
  METHODS
  A longitudinal analysis of the California Office of Statewide Health Planning and Development database from 1995 to 2010 was performed. Inclusion criteria were men who underwent their first penile prosthetic surgery. Patients were excluded if they underwent explantation of a prior prosthesis at the time of their first recorded surgery. Statistical analysis was performed by Kaplan-Meier plot, hazard curve, and multivariate analysis adjusting for age, race, comorbidities, insurance status, hospital volume, and hospital teaching status.
  
  
  METHODS
  Primary outcome was reoperation, specified as the removal or replacement of the prosthesis.
  
  
  RESULTS
  In total, 7,666 patients (40,932 patient-years) were included in the study. The 5- and 10-year cumulative reoperation rates were 11.2% (CI = 10.5-12.0) and 15.7% (CI = 14.7-16.8), respectively. Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year postoperatively and steadily decreased until 2 years postoperatively. Multivariate analysis showed higher rates of reoperation in younger men (hazard ratio [HR] = 1.51, CI = 1.12-2.05), African-American men (HR = 1.30, CI = 1.05-1.62), and Hispanic men (HR = 1.32, CI = 1.12-1.57). Of the reoperations, 22.9% were performed at a hospital different from the initial implantation.
  
  
  CONCLUSIONS
  Reoperation rate for penile prosthetic surgery is highest in the first year postoperatively. Patients with the highest risk for reoperation were African-American, Hispanic, and younger men. Nearly one fourth of reoperations occurred at a hospital different from the initial surgery, suggesting the existing literature does not reflect the true prevalence of penile prosthetic complications.
authors.affiliation: Department of Urology, University California-San Diego Health, San Diego, CA, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mirheydar
authors.affiliation: University of California-San Diego School of Medicine, La Jolla, CA, USA.
authors.forename: Tianzan
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Codman Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Urology, University California-San Diego Health, San Diego, CA, USA. Electronic address: tmikehsieh@ucsd.edu.
authors.forename: Tung-Chin
authors.initials: TC
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D020878:Device Removal; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D015917:Penile Prosthesis / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Complication; Erectile Dysfunction; Penile Prosthetic Surgery; Reoperation; Surgery