Atrium Health Wake Forest Medical Center

Ryan P. Terlecki, MD, FACS, provides physicians with tips for effective communication in prosthetic candidates, recognizing behaviors that might suggest patients have unrealistic expectations, and the best practices for assessing and counseling patients prior to prosthetic surgery.

While urologists familiar with this procedure commonly cite infection and erosion as the most troublesome issues in these patients, Dr. Terlecki argues that patient expectations are the hardest to manage. Oftentimes, patients will exhibit characteristics in the mnemonic CURSED Patient (Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric). Preoperative counseling can help immensely in managing these patients’ expectations. Stressing that the goal of this procedure is not penile lengthening, but rather creating rigidity on demand; the device length is custom-fit to the patient’s anatomy; future lengthening is possible, but not guaranteed; and the truth behind common misconceptions can attribute to patient contentedness.

Planning in all stages of approaching these cases will set up physicians for success, mitigating backlash and pressure to make rash decisions from the patient. Starting with patient selection, it is imperative to judge surgery suitability, health status, relevant history, and body habitus carefully. In addition to these medical considerations, the role of the patient’s partner is a key factor in this decision. Scheduling confirmations on insurance preoperatively; ensuring all products, devices/instruments, and graft materials are available at the time of the surgery; and educating the operating room support staff on specifics in advance can alleviate stressors and complications during the procedure. Confidence in choice of device, surgical approach (penoscrotal vs infrapubic vs subcoronal), and reservoir positioning is also crucial to ensuring optimal outcomes.