Abstract Introduction Penile prosthesis implantation (PPI) is an effective treatment for refractory erectile dysfunction (ED), but changes in penile length after surgery remain a major determinant of patient satisfaction. Objectives We aimed to identify patient- and surgery-related factors associated with final penile length, measured as total implanted device length. Methods We analysed prospectively collected data from the PHOENIX registry, a multicenter cohort including consecutive PPI cases from 30 centers between November 2021 and August 2024 (ClinicalTrials.gov NCT03849586). Baseline demographics, ED history, prior treatments and surgical variables were recorded. Univariate analyses used Mann–Whitney U, Kruskal–Wallis or Spearman correlation as appropriate. Variables significant at p0.05 in univariate analysis and clinically relevant covariates were entered into a multivariate linear regression model. Results After exclusions, 1,072 patients were included (mean age 60.9±9.1 years). Mean total device length was 20.0±2.36 cm (range 6–28). In multivariate analysis, shorter total device length was independently associated with diabetes mellitus (adjusted coefficient −0.59 cm; 95% CI −0.97 to −0.22; p=0.002), history of radical prostatectomy (−0.45 cm; 95% CI −1.01 to −0.11; p=0.04), prior pelvic radiotherapy (−1.42 cm; 95% CI −2.42 to −0.51; p=0.002), Peyronie’s disease (−0.83 cm; 95% CI −1.32 to −0.34; p0.001) and previous intracavernosal injections (−0.68 cm; 95% CI −0.99 to −0.37; p0.001). Use of no sequential corporal dilation was associated with a slightly greater device length (+0.15 cm; 95% CI 0.01 to 0.50; p=0.04). Conclusions Loss of penile length is a well-established cause of patient and partner dissatisfaction following PPI. Pre-operative counselling and management of expectations is critical to the success of the procedure. In this large prospective multicenter cohort, diabetes, radical prostatectomy, radiotherapy, Peyronie’s disease, prior intracavernosal injections and penile curvature correction were associated with shorter implanted device length, whereas higher BMI, vascular disease, treatment with PDE5 inhibitors and no corporal dilation were associated with longer device length. These findings can inform preoperative counselling and surgical planning. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston scientific. Coloplast.
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