際際滷

際際滷Share a Scribd company logo

Patient & Partener Satisfaction after Penile Prosthesis Surgery

T
Tarig Hassan Hag Ali

Penile prosthesis surgery can improve patient and partner satisfaction rates. Studies have found satisfaction rates ranging from 69-97% for patients and 76-96% for partners. Major complications are linked to lower satisfaction, with rates of 1.9% for those with no complications and 25% for those with major complications. Proper patient selection, management of expectations, counseling, and minimizing complications can help improve satisfaction outcomes.

1 of 36
Downloaded 18 times
Patient & Partner Satisfaction after Penile Prosthesis Surgery Dr Tarig Hassan Hag Ali
Erectile Dysfunction (ED) The consistent or recurrent inability to obtain and/or maintain an erection sufficient for satisfactory sexual activity
Prevalence of ED Massachusetts Male Aging Study Men aged 40 to 70 years (N = 1290) *
Treatment options for ED Lifestyle Modification. Medical Phosphodiesterase Type 5 Inhibitors(PDE5i) Vacuum Constriction Device. Intraurethral Rx: MUSE. Intracavernosal Injection: PG, Trimix Penile Prosthesis Sex Therapy/Counseling.
Indications for Penile Prosthesis PPs are considered third-line therapy after inadequate response or inability or refusal to use PDI, intraurethral or intracavernosal injections, and vacuum erection devices.
Evolution of the PenileProsthesis 1936 Borgoraz uses rib cartilage as penile implant 1952 Goodwin and Scott use acrylic prosthesis 1967 Pearman describes placement of rod implant 1973 Scott,Tim and Bradley invent inflatable prosthesis 1974 Small&Carrion design silicone penile implant 1983 3-piece inflatable implant (Mentor) 1998 Viagra (sildenafil) released 2001-present antibiotic coatings,design modifications materialschanges. Le and Burnett. Korean J Urol.2015 Martinez, et al. J Sex Med 2015 Penile Prosthesis
2001-2010 1,763,260 men diagnosed with ED 53,180 implants performed about 5,000 per year Penile Prosthesis (Lee. J Sex Med. 2015)
Complication type Mechanical failure 5-20% Infection 1-3% Erosion 1-11% Corporal crossover Corporal perforation Urethral perforation Glans bowing Risks of penile prosthesis
Patient & Partener Satisfaction after Penile Prosthesis Surgery
Type Advatage Disadvantage Semirigid rod (malleable) Simplest.Cheapest. Has a low chance of malfunction due to the small number of parts Is easy to use for those with limited mental or manual dexterity Simplest surgical procedure Results in a penis that is always slightly rigid Puts constant pressure on the inside of the penis, which can cause injury Can be difficult to conceal under clothing
Type of penile implant Advatage Disadvantage Two-piece inflatable Simple to use Provides flaccidity when deflated Totally concealed in body Is mechanically more complicated than is a semirigid implant Provides less firm erections than does a three-piece implant
Type of penile implant Advatage Disadvantage Three-piece inflatable Creates the most natural, rigid erection Provides flaccidity when deflated Expensive. Has more parts that could malfunction than does any other implant Requires a reservoir inside the abdomen
Treatment satisfaction was defined as having satisfactory intercourse and happiness with the device. Patient Satisfaction Treatment satisfaction Vs Treatment efficacy
Patient Satisfaction is a patients reported outcome that may give both useful insights into the patients perspective on their current treatment and differentiation among alternative treatments.
Pts who were more satisfied with their implant had statistically significant higher partner satisfaction scores, compared with men reporting dis-satisfaction with their device. Pts who were dissatisfied with their implant were more likely to have partners with low female sexual functional scores. Patient & Partner Satisfaction Gittens and colleagues
Patient & Partner Satisfaction Improve type of management. Choose the most appropriate.
Identifying the difficult patient . carrying psychosocial variables that affect operative success and long term satisfaction. CURSED Patient, Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, Psychiatric. Dissatisfaction
Regular follow up. Direct Interview. Doctor administered questionnaires. Patient self-administered questionnaires. ? Telephone. Mailed questionnaires. Patient & Partner Satisfaction
Questionnaire Satisfied Neither satisfied nor dissatisfied Dissatisfied Is the device easy to use? How about the natural feeling of device? Is the rigidity of device adequate to penetrate? Do you experience an orgasm? Do you consider that the device improves your sexual life? Are you satisfied with the device? Would you recommend the device to a friend? Would you undergo the same procedure?
Andrianne,
50 patients AMS 650 and Acu-form penile prostheses patient and partner questionnaires. 70% of the pts and 57% of the partners were satisfied. Improved: frequency of intercourse. sexual desire. ability to achieve orgasm. Salama Satisfaction with malleable prosthesis
Non-satisfaction Dislike for the device Sense of unnaturalness was that for partners. Emphasized the need for proper preoperative counseling for both the patient and his partner, to avoid unrealistic expectations Satisfaction with malleable prosthesis
257 men 2yrs 118 inflatable penile prosthesis (IPP) 139 semirigid penile prosthesis (SPP) pre-operative and post-operative (IIEF) questionnaire. Postoperative EDITS questionnaire . overall major complication rate was higher in IPP improved in IIEF scores in both groups. Halil Bozkurt Satisfaction with penile prostheses
Comparison of patient satisfaction rates for the malleable and two piece-inflatable penile prostheses The modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires six months after implantation 46 patients who underwent malleable AMS 600650 (n=23) Ambicore placement IPP (n=23) Haka n Satisfaction with penile prostheses
Hakan
Literature review 20 years 194 articles >>> only 9 articles Raymond . Henry Satisfaction with inflatable prosthesis
Satisfaction metrics % Patient overall satisfaction 69- 97 Sustained satisfaction 86 - 93 Likelihood of continued use 92- 97 Lack of difficulty in use 91 Confidence in having sex 80 - 91 Ability to have intercourse 83 - 87 Same or improved hardness before ED 84 - 100 Device function 84 Considerably met expectations 82 - 91 Would undergo procedure again 98 Would recommend surgery 86 - 98
Partner satisfaction Satisfaction metrics % Assessment of partner satisfaction 76 - 96 Feels partner wants continued use 93 - 93
Satisfaction metrics % Patient overall satisfaction 69- 97 Sustained satisfaction 86 - 93 Likelihood of continued use 92- 97 Lack of difficulty in use 91 Confidence in having sex 80 - 91 Ability to have intercourse 83 - 87 Same or improved hardness before ED 84 - 100 Device function 84 Considerably met expectations 72 - 91 Would undergo procedure again 98 Would recommend surgery 86 - 98 Penile size Rigidity..Hardness of erection
Predictors of Satisfaction in Men After Penile Implant Surgery Mohamad Habous, 902 patients 2009 and 2015 - 76% malleable implant (MPP) - 24% inflatable implant (IPP) Comorbidity, demographic information. Complications recorded: minor & major . Patient satisfaction.
Patients with a major complication, with or without an additional minor complication, had a higher likelihood of being dissatisfied compared to patients with no complication or only minor complication major complication (25 %) no complications (1.9% ) only minor complications (3.7% ) P < .001 Predictors of Satisfaction in Men After Penile Implant Surgery
The presence of a major complication is linked to a lower likelihood of achieving high satisfaction. Predictors of Satisfaction in Men After Penile Implant Surgery Mohamad Habous, John P. Mulhall, August 2018
Take Home Message PP has the highest SR among all therapies of ED. PP should be offered to patients who failled others. IPP has the highest SR among PP. Malleable implants: cheap, simple & with good SR. Minimizing complications and recognizing difficult patients (CURSED) is important in improving SR.
Preoperative counseling and expectation management Framework Overview Patient selection Identify concerning patient factors and the CURSED patient Initial evaluation of expectations Preoperative optimization Evaluate for pertinent operative risk factors Discuss smoking cessation and glucose control For patients with length concerns, discuss preoperative vacuum or penile traction therapy Informed consent Formal platform to discuss and counsel patient on operative risk, infections and device reliability Device selection Discussion of clinical factors that may effect device selection Highlight appropriate AMS/Coloplast devices Postoperative expectations Candid discussion regarding postoperative changes to penile length and sensation Partner involvement Encourage partner participation and involvement from the initial visit Discuss implications of IPP placement on the dynamics of sexual intercourse Discuss potential benefits of sex therapy for interested couples
Patient & Partner Satisfaction after Penile Prosthesis
Patient & Partener Satisfaction after Penile Prosthesis Surgery

More Related Content

Patient & Partener Satisfaction after Penile Prosthesis Surgery

  • 1. Patient & Partner Satisfaction after Penile Prosthesis Surgery Dr Tarig Hassan Hag Ali
  • 2. Erectile Dysfunction (ED) The consistent or recurrent inability to obtain and/or maintain an erection sufficient for satisfactory sexual activity
  • 3. Prevalence of ED Massachusetts Male Aging Study Men aged 40 to 70 years (N = 1290) *
  • 4. Treatment options for ED Lifestyle Modification. Medical Phosphodiesterase Type 5 Inhibitors(PDE5i) Vacuum Constriction Device. Intraurethral Rx: MUSE. Intracavernosal Injection: PG, Trimix Penile Prosthesis Sex Therapy/Counseling.
  • 5. Indications for Penile Prosthesis PPs are considered third-line therapy after inadequate response or inability or refusal to use PDI, intraurethral or intracavernosal injections, and vacuum erection devices.
  • 6. Evolution of the PenileProsthesis 1936 Borgoraz uses rib cartilage as penile implant 1952 Goodwin and Scott use acrylic prosthesis 1967 Pearman describes placement of rod implant 1973 Scott,Tim and Bradley invent inflatable prosthesis 1974 Small&Carrion design silicone penile implant 1983 3-piece inflatable implant (Mentor) 1998 Viagra (sildenafil) released 2001-present antibiotic coatings,design modifications materialschanges. Le and Burnett. Korean J Urol.2015 Martinez, et al. J Sex Med 2015 Penile Prosthesis
  • 7. 2001-2010 1,763,260 men diagnosed with ED 53,180 implants performed about 5,000 per year Penile Prosthesis (Lee. J Sex Med. 2015)
  • 8. Complication type Mechanical failure 5-20% Infection 1-3% Erosion 1-11% Corporal crossover Corporal perforation Urethral perforation Glans bowing Risks of penile prosthesis
  • 10. Type Advatage Disadvantage Semirigid rod (malleable) Simplest.Cheapest. Has a low chance of malfunction due to the small number of parts Is easy to use for those with limited mental or manual dexterity Simplest surgical procedure Results in a penis that is always slightly rigid Puts constant pressure on the inside of the penis, which can cause injury Can be difficult to conceal under clothing
  • 11. Type of penile implant Advatage Disadvantage Two-piece inflatable Simple to use Provides flaccidity when deflated Totally concealed in body Is mechanically more complicated than is a semirigid implant Provides less firm erections than does a three-piece implant
  • 12. Type of penile implant Advatage Disadvantage Three-piece inflatable Creates the most natural, rigid erection Provides flaccidity when deflated Expensive. Has more parts that could malfunction than does any other implant Requires a reservoir inside the abdomen
  • 13. Treatment satisfaction was defined as having satisfactory intercourse and happiness with the device. Patient Satisfaction Treatment satisfaction Vs Treatment efficacy
  • 14. Patient Satisfaction is a patients reported outcome that may give both useful insights into the patients perspective on their current treatment and differentiation among alternative treatments.
  • 15. Pts who were more satisfied with their implant had statistically significant higher partner satisfaction scores, compared with men reporting dis-satisfaction with their device. Pts who were dissatisfied with their implant were more likely to have partners with low female sexual functional scores. Patient & Partner Satisfaction Gittens and colleagues
  • 16. Patient & Partner Satisfaction Improve type of management. Choose the most appropriate.
  • 17. Identifying the difficult patient . carrying psychosocial variables that affect operative success and long term satisfaction. CURSED Patient, Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, Psychiatric. Dissatisfaction
  • 18. Regular follow up. Direct Interview. Doctor administered questionnaires. Patient self-administered questionnaires. ? Telephone. Mailed questionnaires. Patient & Partner Satisfaction
  • 19. Questionnaire Satisfied Neither satisfied nor dissatisfied Dissatisfied Is the device easy to use? How about the natural feeling of device? Is the rigidity of device adequate to penetrate? Do you experience an orgasm? Do you consider that the device improves your sexual life? Are you satisfied with the device? Would you recommend the device to a friend? Would you undergo the same procedure?
  • 21. 50 patients AMS 650 and Acu-form penile prostheses patient and partner questionnaires. 70% of the pts and 57% of the partners were satisfied. Improved: frequency of intercourse. sexual desire. ability to achieve orgasm. Salama Satisfaction with malleable prosthesis
  • 22. Non-satisfaction Dislike for the device Sense of unnaturalness was that for partners. Emphasized the need for proper preoperative counseling for both the patient and his partner, to avoid unrealistic expectations Satisfaction with malleable prosthesis
  • 23. 257 men 2yrs 118 inflatable penile prosthesis (IPP) 139 semirigid penile prosthesis (SPP) pre-operative and post-operative (IIEF) questionnaire. Postoperative EDITS questionnaire . overall major complication rate was higher in IPP improved in IIEF scores in both groups. Halil Bozkurt Satisfaction with penile prostheses
  • 24. Comparison of patient satisfaction rates for the malleable and two piece-inflatable penile prostheses The modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires six months after implantation 46 patients who underwent malleable AMS 600650 (n=23) Ambicore placement IPP (n=23) Haka n Satisfaction with penile prostheses
  • 25. Hakan
  • 26. Literature review 20 years 194 articles >>> only 9 articles Raymond . Henry Satisfaction with inflatable prosthesis
  • 27. Satisfaction metrics % Patient overall satisfaction 69- 97 Sustained satisfaction 86 - 93 Likelihood of continued use 92- 97 Lack of difficulty in use 91 Confidence in having sex 80 - 91 Ability to have intercourse 83 - 87 Same or improved hardness before ED 84 - 100 Device function 84 Considerably met expectations 82 - 91 Would undergo procedure again 98 Would recommend surgery 86 - 98
  • 28. Partner satisfaction Satisfaction metrics % Assessment of partner satisfaction 76 - 96 Feels partner wants continued use 93 - 93
  • 29. Satisfaction metrics % Patient overall satisfaction 69- 97 Sustained satisfaction 86 - 93 Likelihood of continued use 92- 97 Lack of difficulty in use 91 Confidence in having sex 80 - 91 Ability to have intercourse 83 - 87 Same or improved hardness before ED 84 - 100 Device function 84 Considerably met expectations 72 - 91 Would undergo procedure again 98 Would recommend surgery 86 - 98 Penile size Rigidity..Hardness of erection
  • 30. Predictors of Satisfaction in Men After Penile Implant Surgery Mohamad Habous, 902 patients 2009 and 2015 - 76% malleable implant (MPP) - 24% inflatable implant (IPP) Comorbidity, demographic information. Complications recorded: minor & major . Patient satisfaction.
  • 31. Patients with a major complication, with or without an additional minor complication, had a higher likelihood of being dissatisfied compared to patients with no complication or only minor complication major complication (25 %) no complications (1.9% ) only minor complications (3.7% ) P < .001 Predictors of Satisfaction in Men After Penile Implant Surgery
  • 32. The presence of a major complication is linked to a lower likelihood of achieving high satisfaction. Predictors of Satisfaction in Men After Penile Implant Surgery Mohamad Habous, John P. Mulhall, August 2018
  • 33. Take Home Message PP has the highest SR among all therapies of ED. PP should be offered to patients who failled others. IPP has the highest SR among PP. Malleable implants: cheap, simple & with good SR. Minimizing complications and recognizing difficult patients (CURSED) is important in improving SR.
  • 34. Preoperative counseling and expectation management Framework Overview Patient selection Identify concerning patient factors and the CURSED patient Initial evaluation of expectations Preoperative optimization Evaluate for pertinent operative risk factors Discuss smoking cessation and glucose control For patients with length concerns, discuss preoperative vacuum or penile traction therapy Informed consent Formal platform to discuss and counsel patient on operative risk, infections and device reliability Device selection Discussion of clinical factors that may effect device selection Highlight appropriate AMS/Coloplast devices Postoperative expectations Candid discussion regarding postoperative changes to penile length and sensation Partner involvement Encourage partner participation and involvement from the initial visit Discuss implications of IPP placement on the dynamics of sexual intercourse Discuss potential benefits of sex therapy for interested couples
  • 35. Patient & Partner Satisfaction after Penile Prosthesis