Abstract
Previous studies have shown discrepancies among countries in terms of treatment indications and patients’ management due to different health care policies. Penile prosthesis implantation (PPI) is a highly effective treatment for erectile dysfunction (ED), which may have different accessibility according to the type of health system. We compared clinical characteristics of patients included in two national registries on PPI to investigate the influence of different health care systems on treatment indication and accessibility. The multicenter Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED) Registry and the multicenter Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER), respectively for Italy and North America were considered. Clinical characteristics of patients included in both registries were compared using Wilcoxon Rank Sum test and the Pearson’s Chi square test. Patients submitted to PPI in Italy are significantly younger (age: 61.2 vs. 63.8 years; p ≤ 0.001) compared with North America. The majority of patients are treated for post-radical prostatectomy ED in both registries (Italy: 31%; North America: 27%), although diabetes and cardiovascular diseases are more frequent reasons for PPI in the PROPPER registry (p ≤ 0.001), reflecting differences in disease prevalence among countries. In North America a non-hydraulic implant is considered only in 1% of cases as compared with 3% in Italy (p ≤ 0.001). In terms of postoperative management, a compressive surgical dressing (98% vs. 24%; p ≤ 0.001) is a more common strategy in North America. Finally, in Italy most surgeries are performed in a public hospital (82%), while the private setting (70.8%) is more common in North America (p ≤ 0.001). These findings suggest differences in health care systems between Italy and North America. A system like the American one would guarantee easier access to PPI in countries where the National Health System is mainly based on reimbursement to public hospital settings and where patients choosing private settings have to pay by themselves.
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Acknowledgements
PROPPER Prospective Registry of Outcomes With Penile Prosthesis (PROPPER). Anthony J. Bella, MD University of Ottawa. LeRoy Jones, MD Urology San Antonio Research PA. Bryan T Kansas, MD The Urology Team. Brian Christine, MD Urology Centers of Alabama. Kevin McVary, MD SIU School of Medicine. James Hotaling, MD University of Utah. Mohit Khera, MD Baylor College of Medicine, Eugene Rhee, MD Kaiser Permanente.
INSIST-ED study group
Giovanni Alei12, Gabriele Antonini12, Antonio Avolio13, Marco Bitelli14, Francesco Boezio15, Tommaso Cai16, Enrico Caraceni17, Maurizio Carrino18, Enrico Conti19, Antonio Corvasce20, Nicola Ghidini4, Emilio Italiano21, Giuseppe La Pera22, Alessandro Natali23, Carlo Negro24, Fabrizio Palumbo6, Matteo Paradiso24, Massimo Polito25, Diego Pozza26, Mauro Silvani27, Aldo Tamai28, Massimiliano Timpano29, Lilia Utizi17, Francesco Varvello30, Patrizio Vicini31, Antonio Vitarelli6, Giorgio Franco12
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Deho’, F., Henry, G., Karpman, E. et al. Comparing the Italian and North American prospective registries on penile prosthesis surgery: are there relevant differences in treatment indications and patients’ management?. Int J Impot Res 33, 563–567 (2021). https://doi.org/10.1038/s41443-020-0318-5
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DOI: https://doi.org/10.1038/s41443-020-0318-5
