title: Risk Factors for Removal or Revision of Penile Prostheses in the Veteran Population.
abstract: OBJECTIVE
  To identify comorbid conditions that may increase the likelihood of revision surgery after primary penile prosthesis implantation. To evaluate trends in utilization of prostheses and selection of device within the Veterans Affairs (VA) system.
  
  
  METHODS
  A retrospective review of the VA Informatics and Computing Infrastructure database was performed using Current Procedural Technology codes to identify any Veteran who underwent penile prosthesis surgery between January 2000 and December 2013. Age, race, procedure type, and relevant comorbidities were identified and compared between groups.
  
  
  RESULTS
  A total of 6586 patients underwent primary penile prosthesis placement with at least 1 year of follow-up. Peripheral vascular disease (P <.001), smoking (P <.001), hypertension (P = .012), and history of prostate cancer (P = .043) were each associated with a significant increased risk of revision or removal surgery. There was an increase in overall number of implants placed during the study and increased durability with malleable penile prosthesis (MPP), but there was a downward trend in the number of MPP placed relative to inflatable penile prosthesis (P <.001). MPP were more likely to be placed with increasing age (P <.05) and there was a trend toward increased MPP placement in African Americans compared with Caucasians (P = .06).
  
  
  CONCLUSIONS
  Peripheral vascular disease, hypertension, smoking, and history of prostate cancer are associated with increased risk for secondary surgery. This raises a provocative question of how vascular insufficiency may play a role in the likelihood of secondary surgery after penile prosthesis placement. Utilization of penile prosthesis placement in the VA system is steadily increasing, most notably with increased numbers of inflatable penile prosthesis placement.
authors.affiliation: Cleveland Clinic, Cleveland, OH. Electronic address: johnlacy1@gmail.com.
authors.forename: John M
authors.initials: JM
authors.lastname: Lacy
authors.affiliation: Department of Urology, University of Kentucky, Lexington, KY; Cooper Drive Division, Veterans Affairs Medical Center, Lexington, KY.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Urology, University of Kentucky, Lexington, KY; Cooper Drive Division, Veterans Affairs Medical Center, Lexington, KY.
authors.forename: Shubham
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Surgery, University of Kentucky, Lexington, KY.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.affiliation: Department of Urology, University of Kentucky, Lexington, KY; Cooper Drive Division, Veterans Affairs Medical Center, Lexington, KY.
authors.forename: David M
authors.initials: DM
authors.lastname: Preston
mesh_terms: D020878:Device Removal / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*