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ORIGINAL RESEARCH

Under-recognized factors affecting penile implant satisfaction in

patients

Julie Wong , Luke Witherspoon , Ryan K. Flannigan 1,3
1,2
1
2
3
1 Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Department of Urology, The Ottawa Hospital, Ottawa, ON, Canada; Department of Urology, Weill Cornell Medicine,
New York, NY, United States

Cite as: Wong J, Witherspoon L, Flannigan RK. Under-recognized factors affecting penile implant Introduction
satisfaction in patients. Can Urol Assoc J 2022;16(8):294-300. http://dx.doi.org/10.5489/
cuaj.7720
For patients with erectile dysfunction (ED) that is refrac-
tory to medical management, surgical management in the
Published online March 11, 2022 form of penile prosthesis insertion remains the gold-standard
surgical treatment. Although malleable (non-inflatable) and
two-piece inflatable implants are options, the three-piece
Appendix available at cuaj.ca inflatable penile prothesis (IPP) is the most performed pro-
cedure. IPPs are generally well-tolerated, with studies
1
Abstract reporting an overall patient satisfaction rate of 75–98% and
2-5
a partner satisfaction rate of 85.4%. These satisfaction rates
are similar among different patient subgroups with different
Introduction: Surgical management via penile prosthesis is an
3
option for patients who have failed medical management. There pathologies for their ED. Side effects commonly cited dur-
is a paucity of literature surrounding factors contributing to patient ing patient counselling include decreased penile length and
satisfaction after implant surgery. The objective of this study was to girth, change in penile shape, reduced sensation in the penis,
characterize patients’ and surgeons’ attitudes toward factors affect- chronic pain, mechanical failure, device erosion, infection,
ing satisfaction with this procedure. bleeding, and injury to adjacent structures.
6
Methods: Two patient cohorts were identified and contacted via There is limited literature regarding factors that contribute
email: a medical management of erectile dysfunction (ED) cohort to patient satisfaction post-implant. Preoperative expecta-
and a penile implant patient cohort. A third cohort, Canadian urolo- tions appear to drive overall satisfaction, as demonstrated
gists who perform penile implant surgeries, was also contacted. by patients with lower expectations preoperatively being
The surveys consisted of 5–7 questions, including a rating question associated with higher patient satisfaction postoperatively.
7
regarding the importance of various penile implant factors.
Results: Forty-six ED patients, 45 post-implant patients, and 12 However, to our knowledge, there is no existing study that
urologists completed the survey. The mean overall satisfaction has looked at which specific factors of a penile implant
on a 10-point scale was 6.49 (standard deviation [SD] 2.92). patients find essential to overall satisfaction. Furthermore,
Most (67%) urologists selected patient satisfaction as one of their there has not yet been a study comparing surgeons’ per-
least favorite aspects of penile implant surgery. Compared to post- ceptions to patients’ regarding penile implants and factors
implant patients, ED patients reported greater importance in the influencing patient satisfaction.
areas of appearance (p=0.035), soft glans (p=0.040), and con- The objective of this study was to characterize patients’
cealment of implant (p=0.007). Urologists ranked natural feel and surgeons’ expectations regarding insertion of penile
(p=0.019) and generating a discrete erection (p=0.022) as less implants. Specifically, we wanted to know perspectives
important than patients. from three different cohorts. For patients with ED, we
Conclusions: This is the first study that examines which specific wanted to explore the importance of factors that influence
variables of penile implant surgery are associated with satisfac-
tion while comparing surgeons’ understanding of what patients their impression of penile implants. For patients who have
desire from this surgery. This study identifies several factors deemed received a penile implant, we wanted to explore the most
important by patients but under-recognized by urologists. This important factors and features surrounding their existing
knowledge can aid urologists in optimizing preoperative counsel- penile implants. For surgeons who insert penile implants,
ling and improving patient satisfaction. we wanted to explore the factors they perceive to be most
important to patients when discussing penile implants.

294 CUAJ • August 2022 • Volume 16, Issue 8
© 2022 Canadian Urological Association