Introduction & Objectives: Hydraulic penile prostheses (HPP) have been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life (QoL). We investigated the profile of patients who may benefit the most from HPP.
Materials & Methods: Data from a national multi-institutional database of penile prosthesis including patients treated from 2014 to 2017 in Italy (INSIST-ED) were analysed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single datamanager. Patient’s baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and QoL, all patients were re-assessed at 1-yr follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP). High QoL after surgery was defined as a score higher than the 75th percentile in each subdomains of the QoLSPP. Logistic regression analysis tested the association between clinical characteristics and high QoL after HPP implantation.
Results: Follow-up data were available for 265 patients [median age 62 years (IQR: 56 – 67)] implanted with HPP. Erectile dysfunction (ED) etiology was pelvic surgery/radiotherapy in 41%(81), organic in 39%(77) and Peyronie’s disease in 21%(41). Patients showed good overall QoLSPP scores at 1-yr follow-up for functional (F:22/25), Personal (P:13/15), Relational (R:17/20) and Social (S:13/15) domains. Overall, 27.5%(73) of patients reported high QoL after surgery. These patients did not differ in terms of median age (60 vs. 62); type of prosthesis (tri-component: 90% vs 95%) and post-operative complications (8% vs. 15%) compared to those with lower QoL score (all p>0.1). Conversely, patients with pelvic-surgery/ radiotherapy-ED (49%) and Peyronie’s disease more frequently (p=0.007) reported high QoL compared to men with organic ED (21%); similarly, a higher rate of patients reporting high QoL were treated in centers with a greater surgical volume (median N. of HPP/center: 68 vs. 44; p=0.01). At logistic regression analysis ED etiology was the only factor independently associated with high QoL at 1-year after surgery (p=0.01). Patients treated for ED post-pelvic-surgery/radiotherapy (OR: 2.91; 95%CI: 1.17-7.26) or Peyronie’s (4.14; 95%CI: 1.52-11.2) were more likely to report better outcomes after accounting for age, post-operative complications and surgical volume.
Conclusions: The implantation of HPP is associated with an overall good QoL. However, patients affected by ED post-pelvic surgery/radiotherapy or Peyronie’s disease could benefit the most from HPP in terms of functional outcomes, relationship with their partners and the outside world and perceived self-image.
