Predictors of Patient Willingness to Consider Surgery Prior to Consultation at Sexual Health Clinic.

OBJECTIVES: To identify factors associated with patient willingness to consider surgical treatment for erectile dysfunction (ED) prior to urologic consultation.

METHODS: A prospective database of patients presenting to the sexual health clinic at our institution was created from 2014-2018, consisting of pre-visit patient questionnaires and clinical information. Univariable and multivariable logistic regression analysis was performed to determine factors associated with consideration of surgery and decision to undergo surgery.

RESULTS: Of 1359 men presenting to the clinic, 991 men had a chief complaint of ED with 630 (63.6%) considering surgery. On multivariable analysis, factors significantly associated with pre-visit willingness for surgery included history of diabetes mellitus (p=0.0009), increasing symptom bother (p<0.0001) and decreasing relationship duration (p=0.0005). Approximately 16% (162/991) patients considering surgery prior to consultation ultimately underwent penile implant insertion. Multivariable analysis demonstrated that older age (p=0.003), history of diabetes mellitus (p=0.03), lower IIEF-EF domain (p=0.0009) and history of intracavernosal injection therapy (p<0.0001) were significantly associated with proceeding to ED surgery. Initial declaration of willingness to undergo ED surgery led to nearly 8 fold increased odds for surgery (p < 0.0001).

CONCLUSIONS: Over 60% of patients presenting for ED consultation considered surgical intervention, of whom 25% underwent penile prosthesis. Both patient and relationship factors were predictors of surgical willingness. Pre-visit surgical willingness was associated with highest odds of eventual decision for surgery, suggesting that knowledge of ED treatment options in the general public may play a role. Our findings highlight opportunities for shared decision making in a patient-centered model of care.