Abstract Introduction Erection prosthesis implantation following phalloplasty presents unique technical challenges due to the distinct anatomy of the neophallus. As the demand for gender-affirming genital surgery continues to increase, the absence of standardized recommendations for preoperative assessment, operative technique, and postoperative management remains a significant gap in care. Objective This project sought to reach consensus amongst experts on items for a surgical protocol surrounding perioperative management of penile implants in phalloplasty, with the aim of enhancing uniformity in clinical practice and facilitating future comparative studies. Methods A modified Delphi methodology was employed to generate, refine, and achieve consensus on key recommendations spanning the preoperative, intraoperative, and postoperative phases of care. Participants included urologists and plastic surgeons with extensive experience in gender-affirming genital surgery. Experts were identified through purposive, snowball, and open international recruitment. The steering group comprised six members, supported by a broader expert panel of twenty-one. Two structured voting rounds, defined a priori, were conducted, and items achieving ≥80% agreement were incorporated into the final protocol. Results Of the twenty-one experts who agreed to participate, seventeen completed Round One and sixteen completed Round Two. Consensus was achieved on twenty-seven of sixty-five initial items in the first round. In the second round, eight original and thirty-two revised items were evaluated, with consensus reached on thirty-one. The finalized protocol integrates agreed-upon recommendations across all perioperative stages. Conclusions This international Delphi study achieved expert consensus on a comprehensive surgical protocol for penile implant insertion following phalloplasty. The resulting framework supports consistency in clinical practice and provides a basis for future outcome research. Limitations include limited panel diversity and the absence of patient or community stakeholder perspectives. Disclosure No
Levy et al. (Mon,) studied this question.