The prevalence of preoperative anxiety among patients undergoing insertion of penile prosthesis

Preoperative anxiety (PA) adversely affects surgical outcomes. Compared to other surgical procedures, penile prosthesis implantation (PPI) may result in exceptionally high PA because of concerns about a foreign implant and postoperative patient's and partner's expectations, yet PA in this population has not been previously studied.

This prospective cross-sectional study included all men who underwent PPI in our institute from November 2023 to November 2025. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire was used to determine the degree of PA. Participants were stratified into low (< 11) and high (≥ 11) anxiety groups based on total anxiety scores.

Among 123 participants (mean age: 56.3 years), 52.8% demonstrated clinically significant PA. On univariate analysis, higher PA was associated with education level, number of previous surgical procedures, personal history of surgical or anesthetic complications, duration of surgical consultations, internet information-seeking, discussing surgery with a friend, anesthesia type, and operative duration (P < 0.05 for all). On multivariate analysis, personal history of prior surgical or anesthetic complications and internet information-seeking remained independent predictors of high PA (P < 0.05). Common concerns included device failure (25.2%), inability to activate the device (14.6%), and perceived changes in penile length, girth, or rigidity (12.2%, 9.8%, and 11.4%, respectively).

PA is highly prevalent among men undergoing PPI. Prior personal history of previous surgical or anesthetic complications and internet information-seeking independently predicted high anxiety. This data might help healthcare providers to specifically target this group of patients to decrease the level of PA and its downstream consequences.