How do patient satisfaction rates compare between high‑volume and low‑volume surgeons for penile prosthesis implantation?
Executive summary
High patient satisfaction after penile prosthesis implantation is a consistent finding across the literature, typically reported in the 75–98% range, but studies differ in instruments and settings which limits direct comparisons by surgeon volume [1] [2]. A recent national Medicare analysis shows higher‑volume surgeons have lower reoperation rates—an objective outcome linked to patient experience—but that study did not directly measure patient satisfaction by surgeon volume, so any inference about satisfaction differences is indirect [3] [4].
1. What the data actually measure: satisfaction versus hard outcomes
Most published work on penile prosthesis reports high aggregate satisfaction using varied instruments, with many studies relying on nonvalidated or single‑surgeon surveys, meaning satisfaction metrics are heterogeneous and often not tied to surgeon procedural volume in their designs [2] [5] [1]. By contrast, the national study that specifically examined surgeon volume used Medicare claims to quantify reoperation rates—a hard, objective endpoint—rather than patient‑reported satisfaction, and found lower reoperation rates among higher‑volume implanters [3] [4].
2. What the national volume–outcome study found
In a Medicare cohort of men ≥65 undergoing penile prosthesis from 2018–2021, surgeons’ median annual volume was 14 procedures and reoperation rates at 1 year ranged from 7.4% in the lowest quartile to 5.9% in the highest quartile; multivariable analysis linked highest‑volume implanters with significantly lower reoperation risk, although absolute differences were modest and overall reoperation rates were low [4] [3]. The authors emphasize that outcomes remained acceptable across volume strata, which complicates any sweeping claim that low‑volume care produces poor patient experience [3].
3. How reoperation and complications relate to satisfaction
Complications such as mechanical failure and infection are leading drivers of revision and are plausibly among the strongest negative determinants of satisfaction; the Medicare analysis reported mechanical complications accounted for 41% of reoperations and infections figure prominently in morbidity and cost [3] [4]. Multiple clinical reviews note that avoiding complications, appropriate device selection, and perioperative optimization are key to good outcomes and higher satisfaction, implying surgeons who reduce these risks—often those with more experience—could indirectly boost patient satisfaction [6] [7].
4. Why direct evidence linking surgeon volume to patient satisfaction is thin
No national, patient‑reported satisfaction dataset stratified by surgeon volume was identified in the reporting provided; the volume study measured reoperation, not satisfaction, and many satisfaction studies are single‑center or single‑surgeon series that do not compare across different volume providers [3] [8] [5]. Systematic limitations—nonstandardized questionnaires, single‑surgeon cohorts, and differing implant types—mean current literature cannot conclusively quantify the magnitude of any satisfaction gap attributable solely to surgeon volume [2] [8].
5. Plausible mechanisms and counterarguments
Mechanistically, higher procedural volume plausibly improves technical proficiency, reduces operative time, and lowers complication and revision rates—all of which tend to favor better patient experience—and several retrospective series and reviews have reported worse technical and revision outcomes among low‑volume surgeons [6]. The counterargument, and one explicitly raised by the Medicare study, is that absolute reoperation rates are low and outcomes “acceptable” across volume groups, suggesting many low‑volume surgeons still deliver satisfactory results for most patients [3].
6. Practical takeaways for interpreting satisfaction differences
Clinically meaningful differences in patient satisfaction by surgeon volume remain an evidence gap: patient satisfaction after penile prosthesis is generally high (often >80%), higher‑volume surgeons have lower reoperation rates that likely improve satisfaction for the subset of patients who would otherwise need revision, but direct, patient‑reported comparisons by surgeon volume are lacking and impeded by nonstandard measurement tools [1] [3] [2]. For patients and policymakers, the most defensible position from existing reporting is that surgeon experience matters for certain objective outcomes, and those objective improvements plausibly translate into better satisfaction for some patients, but definitive patient‑reported evidence quantifying that translation is not yet available [4] [3] [9].