Penile Implant Satisfaction Rates in Turkish Men
The goal of prosthetic surgery is to satisfy desires for better function. So just how likely are recipients to be satisfied with newly implanted prostheses? And does level of satisfaction vary by type of prosthesis?
Satisfaction with penile prostheses, a treatment for erectile dysfunction, applies to both the recipient and his partner. It is further complicated by the fact that there are two major brands and several types of prostheses on the market. The three-piece inflatable variant is most commonly implanted and best studied. However, there are situations in which the three-piece inflatable variant may not be ideal and other variants, including malleable semi-rigid prostheses, have a role.
A retrospective study published in the Turkish Journal of Urology used the modified Erectile Dysfunction Inventory of Treatment Satisfaction to measure penile implant satisfaction rates six months after surgery in patients who had other than the three-piece inflatable variant implanted:
• 23 men who received a malleable, semi-rigid prosthesis
• 23 men who received a two-piece inflatable prosthesis
The satisfaction rates were statistically significantly different.
malleable 2-piece inflatable
satisfied 35% 74%
very satisfied 30% 13%
neither satisfied nor dissatisfied 35% 13%
The likelihood of continuing to use the prosthesis were also statistically significantly different.
malleable 2-piece inflatable
very likely 30% 65%
neither likely nor unlikely 35% 21%
very unlikely to use prosthesis 35% 13%
So the question is now why there were differences in the observed rates of satisfaction across prosthesis types. Before one gets too far into this analysis, one has to take into account that this was a retrospective study. In other words, patients were not randomized to receive one type of prosthesis or another. This means that all kinds of self-selection biases may have come into play. For example, it is theoretically possible that patients whose personality is such that they are generally less satisfied tend more than those who are generally more satisfied to choose a malleable prosthesis.
Another theoretical bias may be that patients with manual limitations, as might be the case with men who have rheumatoid arthritis, may select the malleable semi-rigid penile prosthesis. Perhaps such men are less likely to be sexually active, which may explain their answers, irregardless of the type of penile prosthesis they might have received.
The authors appropriately note that doctors can play a role in helping patients to understand their choice of implant. So can partners. Did partners have a role in selecting the prosthesis type? What might have been observed had the study also looked at the most popular type of implant: the three-piece inflatable penile prosthesis? The study sheds light on the critical outcome measure of patient satisfaction and raises many important questions that can and should be answered in future studies.
Surgeo aims to simplify access to quality care. Part of this relates to choice: allowing patients to choose a surgery package that works best for them, meaning the right surgeon, location, and price. Surgeo develops uniformly defined penile implant surgical bundles to make it possible to do an apples-to-apples comparison. So every penile implant surgery package includes choice of prosthesis: malleable semi-rigid, two-piece inflatable, or three-piece inflatable.
The video that follows is a brief summary of the study reviewed above.