Reoperation Rates (Revisions)

[Lost Sheep]

Reoperation Rates for Penile Prosthetic Surgery

I got a PM from another member asking about Reoperation Rates, that is, how many IPPs (Inflatable Penile Prostheses) need to be operation on soon after the initial implant? He was unabgle to post the link successfully, so I thought I would poke around and see what I could find.

Not as deeply studied as satisfaction rates, nor even service life, apparantly. But I (and he) found a couple articles that are interesting.

One suggests that there is a high rate in the first year which slows down after that and then picks up after a decade or so. This makes sense in that if an IPP is going to fail because of defect in the device or the implant surgery, it should go quickly, then if all is well after it is broken in (a year or so) it should last until something actually wears out.

https://www.ncbi.nlm.nih.gov/pubmed/26755095

But then surgeon depth of experience (volume) apparently plays a part, too.

http://www.garber-online.com/pdf/Higher ... ctions.pdf

(This paper has some VERY INTERESTING things to say about surgeon volume and surgical outcomes that bear directly on the common advice found here, "Go to a high-volume surgeon".. But also note that "high-volume" does not necessarily mean thousands. Read the article; I will not try to impose my interpretations on it for you.)

Does anyone else have suggestions about researching this little-studied statistic?

[Tsanchez12369]

Very interesting, seems to indicate drop your chances of needing a replacement due to infection by 50% by going to a doc that does 32 or more implants a year. I wonder what the high volume cutoff is for docs who successfully maximize size?

[ocitgo]

I trust my surgeon but not my hospital. My urologist has been with me for many years. I have been hospitalised many times. I had leukemia 1993 and many hospitalizations. The Fred Hutch was the best. I was in their original hospital. My experiences over here in my town has been a struggle. My son in law is well off and he told me he and his business partners use the better Seattle hospitals. I have been lucky but it has been a struggle especially with leukemia, urology, and vestibular disease.

Lost Sheep, excellent find: a good read for any major disease.
"DISCUSSION Several population based studies have shown a strong association between surgeon volume and postoperative outcomes in urological and non urological surgeries.16e18 Using a cohort of 1,640 Medicare beneficiaries who underwent esophagectomy, Birkmeyer et al found a significant difference in the rates of operative mortality between high and low volume surgeons.17 Leow et al analyzed 90-day postoperative outcomes of radical cystectomy in a nationwide sample of 49,540 cases, and found a 45% decreased risk of major complications and a 46% decreased risk of mortality in patients treated by very high volume surgeons (7 or more cases per year) compared to those treated by very low volume surgeons (1 case per year).18 Process of care factors such as comprehensive preoperative testing and intraoperative hemodynamic monitoring have been proposed as mediators of the differences in radical cystectomy outcomes between high and low volume hospitals."

[fyrbill]

I found what they say and what they do are two different things. When I had my Prostate surgery I made sure my doctor had done over 500 surgeries. I was totally comfortable with him. Turned out in the OR as I was going under he introduced me to the new resident surgeon he was going to train that day using me as the cadaver. Needless to say it was a disaster. The dick head, I use that term for all its intent, clipped one of my nerves. He claimed it was necessary, I say it was newbie nerves. Regardless, move on, get a implant and hope for the best....

[mkehayias]

So-I am 25 days post op having the AMS 700 implanted. I go in for my one month checkup next week. On the 7th I was seen and told to start inflating 2-3 times a day. It is obvious that I will be having a revision. Neither cylinder extends to the glans. The left cylinder is at least 3/8 of an inch shorter than the right. The result is that depending on my body position during inflation, the glans either turns 90 degrees to the left, 90 degrees straight up, or is in line with the shaft but flops around like a ridiculous ball atop a knit cap.

I am thoroughly disgusted. The implant was done by the VA. When the VA diagnosed me with prostate cancer they sent me to a civilian (non-government) specialist, top 20% in his field in the U.S. The prostate came out and the VA stopped paying for the specialist and made me go to a VA hospital. The doctor told my wife that he has done "thousands" of implants. I was seen by the Urology P.A. the day I was admitted for my implant, who told me they had just started doing these procedures. I think the assessment that the rate of revisions based on surgeon experience is higher is spot on. I just hope this guy gets it right on his do-over. I don't get to choose my surgeon...

[Lost Sheep]

So-I am 25 days post op having the AMS 700 implanted. I go in for my one month checkup next week. On the 7th I was seen and told to start inflating 2-3 times a day. It is obvious that I will be having a revision. Neither cylinder extends to the glans. The left cylinder is at least 3/8 of an inch shorter than the right. The result is that depending on my body position during inflation, the glans either turns 90 degrees to the left, 90 degrees straight up, or is in line with the shaft but flops around like a ridiculous ball atop a knit cap.

I am thoroughly disgusted. The implant was done by the VA. When the VA diagnosed me with prostate cancer they sent me to a civilian (non-government) specialist, top 20% in his field in the U.S. The prostate came out and the VA stopped paying for the specialist and made me go to a VA hospital. The doctor told my wife that he has done "thousands" of implants. I was seen by the Urology P.A. the day I was admitted for my implant, who told me they had just started doing these procedures. I think the assessment that the rate of revisions based on surgeon experience is higher is spot on. I just hope this guy gets it right on his do-over. I don't get to choose my surgeon...

So sorry to hear of your cancer and of your substandard outcome. Thank you for you service to our country...you deserve better.

I had similar experience with the V.A, but a far better outcome. Some of it was luck, butsome can be attributed to the adage (Benjamim Franklin) "Diligence os the mother of good luck".

I prepares for an implant 16 months before I got one. I got my Primary Care Physician on board first. I will send you a PM later, but which VA system are you in? I am in the Alaska system, but in my efforts to find a good surgeon, wound up enrolling in the Maryland VA (which gave me access to Dr Kramer) and the PugetSound (Seattle, WA) VA.

[newbie443]

On the second link the bar graph on page 4 indicates that surgeons in the 8-31 a year category are very close to the above 31 category in total reoperations. 5.0 vs. 4.8 respectively. And the 8-31 surgeons do have much higher reoperations for infection than the above 31 surgeons. What stands out to me is that the above 31 surgeons have higher reoperation rates for non infection causes than the 8-31 surgeons. And the larger number of reoperations for non infection than for infection. Looks to me like there are a bunch of really great surgeons that are in that 8-31 category. Wish I had one at my local Uro group.