high volume implantologist

[Fourtytwo00]

It's not about believing. It's just math.

Industry data for US say 20.000 IPP yearly: https://physicians.dukehealth.org/artic ... nt-surgery

Market share of high volume implanters (50 implants per year or more) is 16%.
It means 3.200 penile implants per years in the U.S. There is no room for many "100 or more" surgeries. Sometimes between 10-15 could be a rough estimate.

500 implants per years is almost the number of penile implants performed in France every year.

[Harleydawg53]

When Perito implanted me, I believe he did 7, that morning, when I went for the first consultation,he had at least 40 people preparing for implantation ! He is probably not the most for bedside manor but he is very good at what he does . His staff takes quite a bit of the load off of him !

I didn’t go with him to be his friend, I wanted him to fix my dick ! , and he did exactly that !

I also wanted a surgeon who had probably seen all types of complications, and knew how to deal with any that would arise.

I personally am very satisfied with the outcome “ so far “. Except it’s a little harder to climax ! But I’am only 5- months post op ! Hopefully that gets better .

[Gt1956]

It's not about believing. It's just math.
Industry data for US say 20.000 IPP yearly: https://physicians.dukehealth.org/artic ... nt-surgery
Market share of high volume implanters (50 implants per year or more) is 16%.
It means 3.200 penile implants per years in the U.S. There is no room for many "100 or more" surgeries. Sometimes between 10-15 could be a rough estimate.
500 implants per years is almost the number of penile implants performed in France every year.

Not trying to be argumentative, but a few years ago the members compiled a list of doctors that were considered to be top in the field. As I recall, your 15 is pretty close to what the forum came up with.

[stephen54]

It's entirely credible that the very high volume surgeons are consistently putting up annual numbers in the 300-400 range. Suspend for sake of argument the laughably arbitrary (but necessary) lines in the sand posited by researchers saying "> 20 IPP annually = high volume provider" etc. That doesn't tell you much of value. There should probably be more tiers of separation and physician experience characterization in the analysis. Not that more tiers would inform you who to pick (is the guy doing 19/year that much inferior statistically to the guy doing 22? One is "high" and one is "low"). I'm suggesting there's a wildly more experienced subset of docs of which several do a fairly astounding # of IPPs and that this subset is credibly within the range others speculate (10-15 docs). But that those dozen or so guys still do a kind of startling minority of total IPPs annually when CPT codes are pulled. It's a strange contradiction.

Levine did 4 the day I went in and he does surgery 2x per week, figure 48 weeks a year at that pace and you're easily in the 350-400 range annually, now multiply that by 20+ years of IPP being a dominant proportion of his practice and, even assuming there has been a steady increase over the years with improvements in devices, awareness, insurance coverage, etc, it's easy to conservatively imagine 6,000+ IPPs performed by one guy who is quiet and barely markets himself.

To an earlier poster's thoughts around how many the surgeon does "himself", for sure, there's a reality that there are several IPP Centers of Excellence where you will find urology programs specifically teaching IPP by way of formalized fellowship programs - Levine puts out who knows how many surgeons but I've randomly met 3- and those surgeons leave Rush with a highly specific knowledge of IPP and they go do their own thing wherever they land. To get through a fellowship focused on IPP, that guy needs his hands on the knife, a lot, to learn; the business of surgery is not empiric, it's experiential. So who knows what parts of my surgery Levine actively maneuvered and how many the other guy maneuvered, but the point being, they're both actively engaged in the business of the implant, and Levine is leading, guiding, and poignantly responsible for the results - his name is on it. He's not off in the corner playing solitaire on his phone.

As has probably been referenced, I am sure, somewhere on FT prior...there's some interesting numbers out there around IPP volumes attributed to "high" versus "low" volume surgeons. The New York State analysis is interesting (assuming it can be extrapolated out).

Annualized case log data of penile prosthesis surgeries in New York State over a ten year period from 2003 to 2012 were obtained from the American Board of Urology by pulling CPT code 54400 (used to identify malleable implants) and CPT codes 54401 and 54405 (used to identify IPPs). Goal was to statistically evaluate the association between surgeon characteristics and practice patterns around implantation. One unsettling little nugget:

- 6,615 urologists had placed a total of 9,558 penile prostheses during the 10 year study period.
- 75% of these prostheses were placed by surgeons who completed 4 or fewer such operations per year.


So let that sink in. By a ridiculously overwhelming majority, most IPPs come from surgeons with comically little experience. Although specialists and a very small # of high volume surgeons perform a disproportionate number of implant surgeries, low volume surgeons place (by a crazy margin) the most penile prostheses in the United States. As has been stated elsewhere, that 75% of IPP surgeries have been demonstrated to deliver at least 2x (often more) rate of infection and other adverse events. Unsurprising, where a surgical "best practice" cannot be developed, modeled, nor refined in a world where you do one IPP every 3-4 months.

So the underlying (understandable, and continually expressed) bias toward high volume implanters expressed over and over on FT is on stark display here, and the persistent advice from a lot of the guys here seems directionally extremely wise. Choosing your surgeon solely on volume - not a good idea. Choosing your surgeon without consideration of volume? Also not a good plan. Think of volume as a starting point which then allows you to dig in and really interview the handful you narrow your focus down to.

If you think about it, IPP is a wildly more fractional surgical procedure versus almost any heart procedure. If there are something on the order of 20,000 IPPs done annually in the US, consider that there are something on the order of 500,000 coronary artery bypass graft surgeries done annually. Said another way, for as obviously technical and specialized and critically life-threatening as bypass heart surgery obviously is...IPP in comparison occurs at only 1/25th the rate. So it's highly specialized to say the least.

Beating the drum on this: research, research, ask, ask, ask, ask, verify, verify, repeat...and buy the most experienced set of hands your circumstances will allow.

[Gt1956]

Stephen54, lots to absorb in that post.
A thing to ponder. Its been said that Eid says to look for a doctor in love with his craft. A personality that wants & can improve himself constantly is important. FT as a group should help to identify the better doctors. The question is how to identify them.
The bar to seperate them has been talked about as being as low as 50 a year. 150 is frequently mentioned. I don't know, we might be focusing too much on volume. Is the ultra high number guy measurable better than the 100 a year guy?

[tomas1]

Great post stephen54.

[stephen54]

Stephen54, lots to absorb in that post.
A thing to ponder. Its been said that Eid says to look for a doctor in love with his craft. A personality that wants & can improve himself constantly is important. FT as a group should help to identify the better doctors. The question is how to identify them.
The bar to seperate them has been talked about as being as low as 50 a year. 150 is frequently mentioned. I don't know, we might be focusing too much on volume. Is the ultra high number guy measurable better than the 100 a year guy?

I know. I'm sorry. The morning coffee lights the fuse, for better or worse...

I'm probably mostly with you on that. The "ultra high" vs the "100" a year guy.

It's unlikely that the longitudinal data (data collected sequentially from the same respondents over time to track trends + changes by asking the same respondents questions repeatedly at extended time intervals) put smartly into a graph would show a reliably rising slope linearly connecting the guys from 20 to 50 to 100 to 500 per year.

In other words, as Gt1956 I think correctly wonders...is the (measurable) % of difference between guys as the surgery #s rise, is that steadily increasing at a mostly predictable rate? Or, as guys pass the 50 or 100 mark, is the % differentiation in how they perform extremely rapidly narrowing after they cross a certain # of surgeries? I suspect it is. Then - it gets hard to perform remarkably better the nearer one gets to perfect (or near perfect) outcomes.

Easy to probably extrapolate this out to other highly detailed professions (military aviation, engineering, etc). If United has 5,000 pilots, who are the best few? I don't know. My criteria is my criteria: 1. Don't crash, 2 whatever, 3. whatever, 4. whatever. So of the 5,000 pilots who don't crash, who are the best? I'm sure in the simulators when they're graded out and force ranked, there are all sorts of mind-boggling criteria and judgements made, aimed at fostering their incremental improvement no matter how good they already are.

With our dicks, we want so much more than to just "not crash"!

Fucking statistics

[stephen54]

Great post stephen54.

I just like spreadsheets and coffee, nothing more, hahahaha..

[Gt1956]

Great post stephen54.

I just like spreadsheets and coffee, nothing more, hahahaha..

Beware of data overload or bad data. Btw, data needs an expiration date. Too old of data can poison a decision IMHO.
Somehow, there logically should be a way to sort the doctors into a couple of skill "piles". Number per year looks the best at first glance. But a really slick personality can tilt that metric as easily as a grouch dr can.
I would suggest that teaching others, frequent seminar attendance, being on peer review panels should at least help develope implanting skills. Flipping a lucky quarter, not so much.
I'm open to others opinions on selection criteria that I haven't covered.

[Ronn1708]

Find a higher volume doctor who loves his profession and his patients. One that can speak in plain terms and is approachable pre and post op! I found one that met all the criteria listed and I am so thankful.