Centers of excellence for penile prosthetics are a novel concept that will likely prove difficult to implement
The surgical implantation of penile prosthetics has been evolving over many decades. The operation offers a durable treatment solution associated with a low complication rate and high patient satisfaction. The surgery itself is traditionally taught during urological residency; however, variable patient demographics and faculty expertise leads to differences amongst trainees nationwide. Only 15% of urology training programs have a dedicated prosthetic urologist. Indeed, overall perception of the penile prosthesis amongst general urologists is fraught with misinformation about high complication rates and poor outcomes (1). One strategy to overcome a lack of prosthetics exposure in residency is to have a traveling expert perform one or two operative training sessions (of 3–4 implants) per year (2). Other options include mini-fellowships and weekend courses. The prosthetics manufacturers traditionally sponsor these programs and studies on their effectiveness are limited. In 2015, the majority of penile prostheses (>75%) were placed by urologists who performed fewer than 5 implant surgeries per year (3). Thus, while penile prosthesis surgery is easily considered a low volume surgery for most; it is made exponentially more difficult by the lack of training received.