Open Access

ARTICLE

External validation of a prediction model for penile prosthesis implantation for erectile dysfunction management

Uzoma A. Anele¹, Robert L. Segal^1,2, Brian V. Le¹, Arthur L. Burnett¹

1 The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2 Chesapeake Urology Associates, Baltimore, Maryland, USA
Address correspondence to Dr. Arthur L. Burnett, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-2101 USA

Canadian Journal of Urology 2014, 21(6), 7554-7559.

Abstract

Introduction: Penile prosthesis implantation (PPI) is the definitive surgical treatment for erectile dysfunction (ED), yet it is often delayed for a variety of reasons. From commercial and Medicare claims data, we previously developed a tool for determining a patient’s likelihood of eventually receiving PPI. We validated this instrument’s utility by comparing cohorts receiving surgical (PPI) versus non-surgical ED management at a single institution.
Material and methods: The prediction model was based on a logistic regression incorporating claims data on demographics, comorbidities and ED therapy. A risk score is calculated from the model as the product of relative risks for the individual variables. The current validation was a retrospective analysis of ED patients seen at this institution from January to December 2012. Inclusion criteria included ED diagnosis and either first-time PPI or non-surgical treatment (controls). Risk scores for patients receiving PPI were compared to those of non-surgical controls.
Results: We established a cohort of 60 PPI patients (mean age 54.4 ± 9.5) and compared them with 120 non-PPI patients (mean age 53.4 ± 11.2 years). The median score of the PPI cohort was 5.7 (IQR 2.8–9.9) versus the non-PPI cohort’s 1.8 (IQR 0.9–5.5) (p < 0.0001). The area under the receiver operator characteristic curve for predicting eventual PPI was 0.72 (95% CI, 0.64–0.79) (p < 0.0001).
Conclusion: The prediction model risk-stratified men who ultimately underwent PPI compared to non-surgically managed controls. This external validation study suggests that the prediction model may be used on an individual patient basis to support a recommendation of PPI for managing ED.

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