The Dual-Surgeon Approach for Penile Prosthesis Surgery: A Case Series Highlighting Benefits of This Novel Approach

To assess the outcomes of a dual-surgeon approach to inflatable penile prosthesis (IPP) surgery, where two non-fellowship-trained urologists partnered to perform these procedures following intensive proctoring by an international expert.

A retrospective analysis of patients who underwent 'dual-surgeon' IPP surgery over a 10-year period between August 2008 and July 2018 was performed. Data on patient demographics, peri-operative parameters, complications (Clavien-Dindo system), rate of prosthesis failure, and the necessity of revision surgery were extracted, analysed and compared to published outcomes from high volume institutions.

A total of 175 patients underwent IPP surgery over a 10-year period. The mean age was 64 years (IQR 59-70), the mean operative time was 65.7 min (range 32-157 min), and the mean length of stay in hospital was 1.6 nights (range 1-6 nights). The majority of patients (90.9%) received a Coloplast Titan Implant. The overall complication rate was 22.2% (38/175). Notably, there were no complications > Clavein-dindo grade III. Six patients (3.4%) required revision surgery for mechanical failure.

Dual surgeons performing IPP after intensive training from visiting international experts can achieve comparable outcomes to high volume local and international centres. This strategy of dual-surgeon collaboration should be considered in low volume implanters with no prior fellowship training in prosthetic urology.