Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 17  |  Issue : 2  |  Page : 337-338

Trends in the placement of penile prostheses over the last 17 years in France


1 Academic Department of Urology of La Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6; UPMC University Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
2 Academic Department of Urology of La Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France

Date of Submission10-May-2014
Date of Decision15-Jun-2014
Date of Acceptance06-Jul-2014
Date of Web Publication16-Sep-2014

Correspondence Address:
Morgan Rouprêt
Academic Department of Urology of La Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6; UPMC University Paris 06, GRC n°5, ONCOTYPE-URO, Paris
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1008-682X.139260

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How to cite this article:
Leon P, Seisen T, Mozer P, Beley S, Rouprêt M. Trends in the placement of penile prostheses over the last 17 years in France. Asian J Androl 2015;17:337-8

How to cite this URL:
Leon P, Seisen T, Mozer P, Beley S, Rouprêt M. Trends in the placement of penile prostheses over the last 17 years in France. Asian J Androl [serial online] 2015 [cited 2019 Dec 12];17:337-8. Available from: http://www.ajandrology.com/text.asp?2015/17/2/337/139260 - DOI: 10.4103/1008-682X.139260

Dear Editor,

Erectile dysfunction (ED) currently affects 152 million men worldwide and this number is likely to reach 322 million by 2025. [1] Penile prostheses (PP) placement remains a last-resort option in cases where organic ED has not been cured by previous medications, notably intracavernosal injection and oral phosphodiesterase type-5 inhibitor. [2]

France ended 2013 with a population of 66 million inhabitants. In our study, we obtained data through the French national code registry database programme de mιdicalisation des systθmes d'information and from the patient-information forms filled out by the surgeon at the time of the implant. For claim purposes, this system comprehensively records information concerning every surgical procedure that is performed in a private or public hospital in France. Data were extracted for all patients who had undergone a penile implantation between 1997 and 2013.

Overall, 6982 PP were inserted over the last 17 years in France. We found that 2821 PP were implanted in France between 1997 and 2005 (i.e. mean number of 352.6 PP per year), and 4161 PP between 2006 and 2013 (i.e. the mean number of 594.4 PP per year) ([Figure 1]). Although the number of PP placements has increased considerably over this period, PP appears to be still underutilized in France compared with the USA, where they are used to treat ~ 10% of impotent men. [3] In addition, in the future, even more men are likely to develop ED associated with diabetes or other comorbidities, such as metabolic syndrome.
Figure 1: Trends in penile prosthesis implantation between 1997 and 2013 in France.

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Overall, we found that 1182 revisions (16.9%) and 2264 explanations (32.4%) of PP occurred over the 17 years period ([Table 1]). PP implantation can require later revisions or even removal due to complications (i.e. infections or mechanical issues). In the literature, the main complication was infection, which developed in 1.7%-6.6% of cases. [4] In the largest French previous series, of 282 PP, sepsis occurred in 2.2% of cases, 5.6% of cases had mechanical dysfunction, and 9.3% of cases were in the iterative poses. [5] Wilson et al. [6] estimated that only 60% of first PP implants would survive for >15 years without revision or extraction. PP is efficacious in most men and have a satisfaction rate of 81% compared with 51% with sildenafil and 40% with intracavernosal injections. [4],[5],[6],[7],[8]
Table 1: Trends in the numbers of PP devices implanted, the need for revision, and the explanation procedures used in France since 1997


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As yet, PP is only implanted, in France, in a limited number of tertiary referent centers. It would be of benefit if these centers communicated with general practitioners and the general population on this successful therapeutic approach. In the light of current data, PP may be underused in France because medical personnel and the general population have little information on this therapy.

Finally, PP is really an expensive procedure, and cost can become an issue in many countries since few patients have the ability to afford the price of the device. However, the cost is not an issue in France as the health care system refund patients who require a PP, notably those who have diabetes and prostate cancer. Indeed, public hospitals do buy prostheses. The possibility of PP placement may depend on factors-related to catchment areas, patient recruitment, management, and strong differences in health care systems from country to another in the western world. Thus, we have no data to make a direct comparison between countries, and it is difficult to know whether these considerations can be translated in other countries.


  Author Contributions Top


PL and TS extracted national data. PL and PM wrote the manuscript. SB was involved in the critical revision of the manuscript. MR was a senior author and initiated the conception and the draft of this letter.


  Competing Interests Top


The authors declare that they have no competing interests.

 
  References Top

1.
Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50-6.  Back to cited text no. 1
    
2.
Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010; 57: 804-14.  Back to cited text no. 2
    
3.
Carson CC. Diagnosis, treatment and prevention of penile prosthesis infection. Int J Impot Res 2003; 15 Suppl 5: S139-46.  Back to cited text no. 3
    
4.
Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, et al. Chapter 1: the management of erectile dysfunction: an AUA update. J Urol 2005; 174: 230-9.  Back to cited text no. 4
    
5.
Menard J, Tremeaux JC, Faix A, Staerman F. Penile protheses multicentre practice evaluation, results after 282 procedures. Prog Urol 2007; 17: 229-34.  Back to cited text no. 5
    
6.
Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med 2007; 4: 1074-9.  Back to cited text no. 6
    
7.
Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int 2006; 97: 129-33.  Back to cited text no. 7
    
8.
Chung E, Solomon M, Deyoung L, Brock GB. Clinical outcomes and patient satisfaction rates among elderly male aged ≥ 75 years with inflatable penile prosthesis implant for medically refractory erectile dysfunction. World J Urol 2014; 32: 173-7.  Back to cited text no. 8
    


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