Quality of life outcomes following penile prosthesis insertion in the post-ischaemic priapism setting

Penile prosthesis insertion is recommended for long-duration ischaemic priapism patients with refractory erectile dysfunction. There is a paucity of published data focusing on long term outcomes and quality of life reporting for patients in this setting. We contacted patients who had a post-ischaemic priapism penile prosthesis inserted in our department via telephone and conducted the previously validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Question items were answered on a Likert scale from 0-5 with satisfactory scores ≥3. Two-tailed Z-tests were used to determine satisfactory scores at significant levels (p < 0.05). We chose to add two additional questions on regret and feelings towards living the rest of their lives with a penile prosthesis. 167 patients had penile prostheses inserted post- ischaemic priapism between 2002-2022. Of these, 39 (23.4%; implants between 2007-2021) completed our questionnaire. The median age was 56 years (IQR 50-63) with a median time to questionnaire post-ischaemic priapism of 9 years (IQR 3-11). Analysing the QoLSPP mean item responses, the penile prosthesis resulted in satisfactory scores in 7 of 16 QoLSPP questionnaire items: device adequacy, device rapidity, device duration, meeting expectations, contentment with life, general well-being and sexual experience. The pooled mean score by domain was 3.7 ± 1.2 for functional, 3.3 ± 1.4 for relational, 3.2 ± 1 for social and 3.4 ± 1.1 for personal. Sub-group analysis demonstrated no significant difference in mean score by prosthesis type (inflatable versus malleable). Ten respondents cited specific reasons for how the penile prosthesis caused dissatisfaction. All 39 respondents (100%) answered 'yes', they did not regret penile prosthesis insertion as a treatment option and that they would be satisfied living the remainder of their lives with a device in situ. This study can be used to inform patient counselling, that penile prosthesis insertion is a suitable surgical technique to maintain sexual function post-ischaemic priapism.