Open Access

ARTICLE

Rural Medicare patients less likely to undergo penile prosthesis implantation following radical cystectomy

Omar M. Dawood¹, Daniel J. Sadowski², Steve Scaife³, Nicholas N. Tadros¹, Robert H. Blackwell¹

1 Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
2 Rockford Urological Associates, Rockford, Illinois, USA
3 Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
Address correspondence to Dr. Daniel J. Sadowski, Rockford Urological Associates, 351 Executive Pkwy., Rockford, IL 61107 USA

Canadian Journal of Urology 2020, 27(6), 10461-10465.

Abstract

Introduction: Erectile dysfunction is common after radical cystectomy; however, research on sexual dysfunction after this procedure is relatively scarce. Our goal was to evaluate the incidence of penile prosthesis implantation after radical cystectomy, with a focus on rural/urban disparity.
Materials and methods: We used the SEER-Medicare database to identify patients with bladder cancer diagnosed between 1991-2009 who had a radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79). The outcome was placement of a penile implant (ICD-9 codes 64.95 and 64.97). Covariates extracted included rural county status, age, race, ethnicity, marital status, geographic region, socioeconomic status, Charlson comorbidity, pathologic cancer stage, and type of urinary diversion.
Results: A total of 95 penile implants were performed in the 11,477 cystectomy patients (0.83%). Patients who had a penile implant were mostly from urban counties (85.1%) and in the Western region of the United States (83.9%). After controlling for covariates, rural patients who underwent an ileal conduit for urinary diversion were less likely to have a penile prosthesis procedure after radical cystectomy.
Conclusions: Penile prosthetic procedures are uncommon in bladder cancer patients who have undergone radical cystectomy; therefore, sexual health should be considered and discussed with patients after radical cystectomy.

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