(690) The Use of Patient Decision Aids in Penile Implant Surgery

Abstract Introduction Patient decision aids (PDAs) have been utilised in a variety of urological conditions, leading to improved patient satisfaction with treatment decisions and the decision-making process. Shared decision-making is advocated by NICE, EAU and the AUA, and is recognised as a core component in delivery of optimal health care and reducing patient regret. However, there has been no research into determining the factors which are important to patients in implant surgery. This study aims to determine which factors are most important to patients when making decisions regarding implant surgery. Objective To develop a penile implant PDA and assess the important parameters in patient penile implant choice. Methods A multicentre retrospective assessment of a penile implant PDA in men attending a penile implant counselling clinic was performed. The penile prosthesis PDA included general information on the risks and benefits of penile implants, available brands (Boston Scientific or Coloplast), and options for malleable or inflatable penile prostheses. Patients were invited to provide free-text responses regarding their rationale for why a specific implant may or may not be suitable. Additionally, patients completed a 13-point questionnaire in which they ranked,out of 10, what implant attributes were most important; 10 being the highest importance, as well as to identify the 3 most important parameters to them. All centres offered both Boston Scientific and Coloplast malleable and inflatable penile implants. Results 41 men returned completed forms. All parameters, except the number of component parts and length of surgery received a median score above 5. The highest median scores were received for implant rigidity (10), ease of use (9), life expectancy of implant (9) and infection reduction (9). Only 23 patients ranked their top 3 parameters. The most frequent parameters reported in the top 3 were implant rigidity (52%), length with implant in situ (49%) and girth with implant in situ (34%). Conclusions This is the first study to describe the use of PDAs in penile implants. The findings suggest patients have a high level of concern for almost all aspects of penile prosthesis insertion. Careful counselling with both a PDA and physical interaction with the actual prostheses could aid in patient decision making regarding the optimal device for them. Furthermore, whilst penile prosthesis provide a rigid scaffold for sexual intercourse, length and girth are of the utmost importance to patients and therefore it must be impressed on them the limitations of current available prothesis in achieving their prior natural erection. Our study provides an important framework for counselling patients pre-procedure to ensure they are fully informed to prevent dissatisfaction and ultimately implant regret. Disclosure No