Survey reveals why patients discontinue IPP use

Springfield, IL-Ten percent of men with penile implants express dissatisfaction with their implant, and 12% either do not use their implant or use it less often than desired, according to data from a patient registry known as PROPPER (Prospective Registry of Outcomes with Penile Prostheses for Erectile Restoration). 

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Dr. KöhlerThe most common reasons given for not using the implant or using it less than desired are penile length concerns, problems with the pump, a decline in health, and partner issues, said first author Tobias Köhler, MD, MPH, at the 2015 AUA annual meeting in New Orleans.

The vast majority of studies on implant satisfaction “hover around 90%” for satisfaction, said Dr. Köhler, associate professor and residency program director at Southern Illinois University, Springfield. Those data were single series and retrospective in nature.

At the time of Dr. Köhler’s analysis, the PROPPER registry had 958 patients enrolled from 11 sites in the U.S. and Canada. Patients with malleable implants or inflatable prostheses are included. Patients answered questionnaires at baseline and annual follow-up, including questions about satisfaction with their devices. As part of the survey, patients checked boxes that corresponded to their level of satisfaction, but could also write in the reasons for their dissatisfaction or non-use of the devices (or use less often than desired). These responses were abstracted into common themes.

At 1 year, 518 patients had completed follow-up. Ten percent expressed dissatisfaction at 1 year, a finding that remains consistent at 2 years, at which time follow-up data were available for 296 patients.

Next: Reasons for not using device reported

Reasons for not using device reported

Twelve percent of the patients reported not using their device (11.6% at 1 year and 12.8% at 2 years). The most common reason cited was device dissatisfaction (2.9% at 1 year follow-up and 3.7% at 2 years). Twelve percent also indicated that they used their device but not as often as desired (10.0% at 1 year; 13.9% at 2 years).

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Device dissatisfaction was cited by 1.2% at 1 year and 0.3% at 2 years as the reason for less use than desired. A device problem was given as the reason for less use than desired by 0.8% at 1 year and 0% at 2 years. Reasons other than device dissatisfaction, device problem, health decline, loss of partner, and partner disinterest were cited by 8.3% at 1 year and 9.8% at 2 years.

Of those that indicated “other” reasons for not using the device, most referred to problems with the device, most often related to the pump, cited by 26% at 1 year and 42% at 2 years; device dissatisfaction most often related to length, cited by 26% at 1 year and 31% at 2 years; health decline (22% at 1 year and 25% at 2 years), and partner issues including partner loss or disinterest (20% at 1 year and 8% at 2 years).

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Other reasons given for less use than desired were similar to “other” reasons for non-use: health decline (43% at 1 year and 67% at 2 years), device dissatisfaction most often related to length (29% at 1 year; 6% at 2 years); device problems, most often related to the pump (17% at 1 year; 3% at 2 years); and partner issues (15% at 1 year; 22% at 2 years).

Next: No difference in 1-year satisfaction or dissatisfaction rates when comparing devices with least to most rear tip extenders used.

“On average, most guys in our series had an 18-cm device with 2 cm of rear tip,” Dr. Köhler said. There was no difference in 1-year satisfaction or dissatisfaction rates when comparing devices with least to most rear tip extenders used.

“Attrition bias is most certainly going to be prevalent in perhaps these overly optimistic rates,” he said. “Some of these guys may not have filled out questionnaires because they were unhappy, and thus dropped out of the study. We have to keep that in mind.”

The data can aid in preoperative counseling of implant candidates and provide a realistic expectation to the patient and provider, he said.

The PROPPER Registry is sponsored and funded by American Medical Systems.

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