What preoperative counseling or expectations do patients wish they had received before penile implant surgery?

1. What patients most regret hearing too late: honesty about size and sensation

A recurring theme across multiple studies is that perceived loss of penile length and altered penile sensation are the most common drivers of postoperative disappointment, and patients report wishing these outcomes had been discussed in plain terms beforehand ^{[2] [4] [5]}; reviewers and outcome studies therefore recommend explicit counseling on likely size, girth and consistency of the erect penis and on potential changes to penile sensation and ejaculation ^{[2] [6]}.

2. The need for balanced device education and shared decision‑making

Patients want a guided walkthrough of device categories, how the 3‑piece versus 2‑piece or malleable options feel and function, reservoir and pump placement tradeoffs, and which device characteristics match their priorities, because device selection is nuanced and influences long‑term satisfaction ^{[1] [6] [7]}.

3. Clear disclosure of risks that matter: infection, malfunction, and revision

Men say they wish surgeons had emphasized the small but meaningful risks—device infection (quoted by reviewers at roughly 1% in virgin implants), mechanical failure and potential need for revision—along with how risks change with prior surgery, comorbidities or revision cases, so patients can weigh benefits realistically ^{[1] [8] [9]}.

4. Practical recovery expectations and actionable preparation

Patients report benefit from concrete preop guidance: timeline for return to activity and sexual use, anesthesia and fasting instructions, wound care, need for someone to escort them after discharge, and when to expect instruction on using the implanted pump—details that reduce anxiety and improve functional outcomes ^{[10] [7] [1]}.

5. Psychological screening, partner inclusion and managing relational expectations

Structured preoperative psychological evaluation identifies roughly a quarter of candidates who may need counseling before proceeding, and patients frequently wish partners had been included in counseling so relational expectations (intimacy, performance, emotional adjustment) were set jointly rather than assumed ^{[11] [3] [7]}.

6. Personal risk profiling and surgeon experience matter to outcomes

Candidates want individualized risk conversations: how obesity, prior radical prostatectomy, Peyronie’s disease, corporal fibrosis or spinal cord injury raise the odds of shorter length, more complications or lower satisfaction—and they want to know their surgeon’s volume and complication rates because low‑volume operators have been linked to worse outcomes ^{[2] [9] [8]}.

7. Contested clinical details patients wish someone had explained

Patients express confusion over specific perioperative practices—such as the benefit versus uncertainty around postoperative antibiotics, preop traction/vacuum therapy to maximize length, and “no‑touch” techniques to reduce infection—areas where expert opinion and guidelines diverge and which deserve transparent explanation in counseling ^[1].

8. The payoff: realistic expectations correlate with satisfaction, and where counseling can fail

Multiple studies show that lower or more realistic preoperative expectations predict higher postoperative satisfaction, meaning honest, standardized counseling isn’t just ethical—it measurably improves outcomes; conversely, inadequate counseling or “surgeon shopping” and unrealistic patient beliefs are repeatedly flagged as causes for dissatisfaction ^{[12] [9] [4]}.

9. Hidden incentives and alternative perspectives to watch for

Cosmetic, commercial or institutional pressures can subtly shape counseling: device manufacturers and centers may emphasize high satisfaction rates while downplaying nuanced complications or quality‑of‑life tradeoffs; balanced preop counseling must therefore disclose alternatives, costs and limitations as recommended by standardized programs at high‑volume centers ^{[7] [6]}.

Conclusion: what patients wish clinicians would do differently

Patients consistently ask for structured, documented, shared decision‑making that addresses probable size and sensation changes, device options, individualized risk profiling and recovery logistics, plus partner inclusion and, when indicated, psychological preparation—because clear, standardized preoperative counseling is the single intervention most associated with higher satisfaction after penile implant surgery ^{[3] [6] [11]}.