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Long-Term Survival Rates of Inflatable Penile Prostheses: Systematic Review and Meta-Analysis
Larry E Miller1, Mohit Khera2, Samir Bhattacharyya3
1Miller Scientific, Johnson City, TN.
Abstract:
The purpose of this study was to determine long-term survival of inflatable penile prosthesis (PP) and identify potential factors that may influence device survival. We performed a systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies of men treated with inflatable PP with at least 5 years of device survival data. We performed a random effects meta-analysis to estimate device survival at 1, 3, 5, 10, 15, and 20 years of follow-up. The robustness of the meta-analysis results was evaluated in a 1-study removed sensitivity analysis and sources of heterogeneity among studies were investigated with subgroup analysis. In 12 studies (20,161 patients; median age 57 years), PP device survival was 93.3% at 1 year, 91.0% at 3 years, 87.2% at 5 years, 76.8% at 10 years, 63.7% at 15 years, and 52.9% at 20 years. The results of the meta-analysis were not significantly influenced by single study effects in a 1-study removed sensitivity analysis. In a subgroup analysis, 5-year device survival rates were 90.6% vs 82.1% (P = .01) comparing newer vs older studies; no other patient or study design characteristic was statistically associated with device survival rates. In conclusion, the median device survival time of an inflatable PP is approximately 20 years. The factors responsible for improved device survival in newer studies remain unclear and warrant further study.
Insights
The long-term survival of inflatable penile prostheses (PP) is approximately 20 years. Newer studies show improved PP survival rates, though factors influencing this remain unclear and require further investigation.
Area of Science:
- Urology
- Medical Devices
- Prosthetics
Background:
- Penile prosthesis (PP) implantation is a treatment for erectile dysfunction.
- Understanding long-term device survival is crucial for patient counseling and device selection.
Purpose of the Study:
- To determine the long-term survival rates of inflatable penile prostheses (PP).
- To identify factors influencing the survival of penile prostheses.
Main Methods:
- A systematic review of Medline, Embase, and Cochrane Central Register of Controlled Trials was conducted.
- A random-effects meta-analysis estimated device survival at various time points (1-20 years).
- Sensitivity and subgroup analyses were performed to assess robustness and heterogeneity.
Main Results:
- In 12 studies including 20,161 patients, PP survival was 93.3% at 1 year, decreasing to 52.9% at 20 years.
- Five-year survival rates were higher in newer studies (90.6%) compared to older studies (82.1%, P=.01).
- No other patient or study design characteristics were significantly associated with device survival.
Conclusions:
- The median survival time for an inflatable penile prosthesis is approximately 20 years.
- Improved survival in newer studies suggests advancements, but the specific factors are not yet identified.
- Further research is needed to elucidate the reasons behind improved device survival in recent studies.
