Practice patterns of Canadian penile prosthesis implanters

Introduction: Penile prosthesis implantation is a well-established treatment for refractory erectile dysfunction; however, significant variations exist in surgical techniques and practice patterns, often influenced by individual surgeon experience and training. Our study aimed to identify these variations among Canadian implanters, assessing their approach to penile prosthesis surgery. Methods: A cross-sectional, questionnaire-based study was conducted to evaluate the practice patterns of Canadian surgeons performing penile prosthesis implantation. The study included implanters from all provinces who perform more than five cases annually. An anonymous electronic survey was distributed, assessing practice patterns, surgical approach, and recommendations for improving penile prosthesis surgery in Canada. Results: Seventeen Canadian urologists performing over five annual cases participated in the study, with the annual volume varying among respondents. The majority (88.2%, n=15) routinely checked HbA1c levels, with 54.5% (n=6) using a cutoff of 8%. Additionally, 58.8% (n=10) routinely ordered a urine culture, and 94.1% (n=16) performed a preoperative scrub. Juts over half (52.9%, n=9) prescribe preoperative antibiotics, the majority (88.2%, n=15) used an antibiotic dip, and postoperatively, 94.1% (n=16) of respondents prescribed antibiotics. Most implanters (76.5%, n=13) primarily used a penoscrotal approach and 47.1% (n=8) did not routinely place a drain. Respondents also indicated perceived ways to improve penile prosthesis education across Canada, focusing on patient education and surgical simulation. Conclusions: While key aspects, such as the ideal surgical approach, HbA1c cutoffs, antibiotic regimens, and intraoperative techniques, remain debated, our findings underscore the need for further standardization. High-quality educational resources and consensus guidelines could help implanters refine their practice and improve patient outcomes.