What standardized counseling protocols for penile implants have been published by high‑volume centers and how do they differ?
Executive summary
High‑volume centers have begun publishing standardized preoperative counseling protocols that codify shared decision‑making, risk profiling, psychological screening, and expectation management for penile prosthesis implantation, led by a notable “center of excellence” flowchart approach from Van Huele et al. and framed alongside short SMSNA consent guides and international consensus statements; the protocols agree on core topics but differ in depth, tools used, and perioperative recommendations such as antibiotics and reservoir planning [1] [2] [3]. Variation reflects gaps in Level‑1 evidence and differing institutional experience: some centers emphasize structured psychological screening and validated questionnaires, while others prioritize practical flowcharts and surgeon‑driven risk stratification [4] [5] [6].
1. What high‑volume centers published as “standardized counseling”
A high‑volume European center led by Van Huele, Lenaers, and Renterghem published a concise standardized preoperative counseling protocol that centers on shared decision‑making, an expectation‑management flowchart, and a conservative “underpromise/overdeliver” strategy to reduce dissatisfaction after inflatable penile prosthesis (IPP) surgery [1] [5]. That work is explicitly described as a standardized approach from a center of excellence and has been referenced repeatedly in narrative reviews and outcome papers as an exemplar of practical preoperative counseling [7] [8].
2. Content common to most standardized protocols
Across high‑volume reports and reviews the counseling core is consistent: explanation of device types and permanence, infection and revision risks, possible changes in penile length and sensation, mechanical failure, and realistic postoperative sexual function goals; these topics appear in the SMSNA short informed‑consent guide and in major reviews and textbooks that inform clinical practice [2] [9] [10]. International consensus groups similarly emphasize frank discussion of psychosocial and cosmetic consequences and the need to match patient risk profiles to surgical choices [3].
3. Where centers differ: structure and tools
Differences arise in format and depth: Van Huele’s center promotes a flowchart and an institutional shared‑decision framework to standardize conversations [5], whereas the SMSNA guide is a brief checklist designed for clinician use during informed consent [2]. Psychological screening protocols used in some specialized centers employ validated instruments to identify patients “unfit” for surgery (with ~25–28% classified as needing further counseling), a level of preoperative psychosocial triage not always present in shorter consent tools [4].
4. Where centers differ: technical counseling and risk tailoring
High‑volume risk‑profiling papers recommend procedure‑specific counseling—e.g., reservoir placement options after prior abdominal surgery, or tailored counseling for revision cases and subgroups (Peyronie’s disease, post‑prostatectomy) who face different satisfaction probabilities—points highlighted in risk‑profiling and specialist reviews [6] [11]. The international forum and Asia‑Pacific consensus also recommend discussing staged vs synchronous procedures for combined reconstructive needs, again reflecting different institutional emphases [3] [12].
5. Perioperative practice differences that affect counseling
Counseling diverges on perioperative management where evidence is weak: antibiotic prophylaxis duration is contested—AUA policy recommends <24 hours while many North American prosthetic surgeons favor 5–14 days—so centers counsel patients differently about postoperative antibiotics and associated risks [6]. Similarly, recommendations about timing after other genital surgeries (for example, waiting ~6 months after urethroplasty or phalloplasty before implanting a device) are practiced in specialized centers and reflected in gender‑affirming surgery reviews [13].
6. Implicit agendas, evidence gaps and practical consequences
Published center protocols often aim to reduce dissatisfaction and litigation by standardizing consent, but they also reflect local resources and surgeon experience—centers promoting formal psychological screening or extended antibiotics presuppose access to mental‑health services or institutional infection‑control philosophies that are not universally available [4] [6]. Importantly, authors and consensus panels note a paucity of randomized trials and call for prospective registries to validate which counseling elements materially improve outcomes [7] [5].