Versorgungswirklichkeit der urologischen Endoprothetik in Deutschland von 2006 bis 2016

BACKGROUND: Treating urinary incontinence and erectile dysfunction improves quality of life for many patients. In particular, sphincter and penile prostheses achieve very good results when conservative therapy options are exhausted. The aim of this study is to present the development and current state of sphincter and penile prosthesis implantation in Germany. MATERIALS AND METHODS: We carried out an analysis of the Diagnosis Related Groups billing data in Germany from 2006–2016. We described the state of care in 2016 based on the German hospitals’ quality reports. RESULTS: Between 2006 and 2012 implantations of sphincter prostheses in Germany increased from 739 to 1112 (p < 0.001), the amount of implanting hospitals also increased from 129 to 206 (p < 0.001). From 2012–2016, the number of cases decreased to 980 and the number of hospitals to 198. In 2016, 168 (88%) urological hospitals implanted 1–9 sphincter prostheses and 23 (12%) hospitals implanted ≥ 10 sphincter prostheses. The top 10 hospitals (≥20 sphincters) implanted 34% (283/839) of all sphincters. Between 2006 and 2013 the number of implanted penile prostheses continuously increased from 263 to 503 (p < 0.001), the number of implanting hospitals from 71 to 107 (p < 0.001). From 2013–2016, the number of cases (p = 0.9) and the number of implanting hospitals (p = 0.5) stagnated. The proportion of penile prostheses implanted as part of gender reassignment surgery increased from 17% in 2006 to 25% in 2016 (p = 0.03). In 2016, 83 (85%) urological hospitals implanted 1–6 penile prostheses and 14 (15%) hospitals implanted ≥ 7 prostheses. The 7 top hospitals (≥20 prostheses/year) implanted 232/448 (52%) of the prostheses. CONCLUSIONS: The current state of urological endoprosthetics in Germany shows a small number of high-volume centers, but also a large number of hospitals with a small number of cases. Since 2012/2013, there has been a stagnation in the number of cases of penile and sphincter prosthesis implantations. In view of the number of radical prostatectomy cases, this development suggests an undersupply.