Background Non-organic erectile dysfunction (ED) and premature ejaculation (PE) are common conditions for which European Association of Urology guidelines lack specific recommendations on penile prosthesis implantation (PPI). Aim To establish expert consensus on the role of PPI in non-organic ED and PE using the Delphi method. Methods A panel of 24 international penile implant surgeons with significant experience in PPI participated in a 3-round Delphi consensus between February and May 2025. Participants were mainly European-based (Italy, n=16; Turkey, n=4; United Kingdom, n=2; Spain, n=1; Germany, n=1). Two online questionnaire rounds were followed by a final virtual meeting. Topics included diagnostics, treatment hierarchy, indications for PPI, ethical concerns, surgical risks, patient satisfaction, partner’s involvement, and follow-up strategies. Consensus was defined as ≥75% agreement or disagreement on Likert-scale items. Outcomes Expert consensus was reached on all 53 items, including the ones regarding the appropriateness of PPI in non-organic ED and PE. Results Experts agreed on the importance of thorough psychosexological assessment, standardized diagnostic tools, and exhausting conservative treatments before considering PPI in non-organic ED. Seventy-five percent supported PPI as a last-resort option in non-organic ED, provided psychological evaluation and informed consent protocols are in place. In contrast, the panel rejected PPI as a treatment for pure PE due to insufficient evidence and lack of clinical experience. Emphasis was placed on ethical safeguards, long-term follow-up, and partner involvement in decision-making. Clinical Implications These findings suggest that, under strict conditions, PPI may have a role in treatment-resistant non-organic ED but not in pure PE. Strengths and Limitations Limitations include the inherent subjectivity of the Delphi methodology and the restricted representativeness of the panel, which was mainly European-based and composed exclusively of urologists specializing in penile implants. Conclusion Selective use of PPI in non-organic ED is supported by expert consensus, while its use in pure PE is not; updated guidelines and further research are warranted.
Evaluating the appropriateness of penile prosthesis in non-organic erectile dysfunction and premature ejaculation: a Delphi consensus among penile implant surgeons
Capogrosso P.;
2026-01-01
Abstract
Background Non-organic erectile dysfunction (ED) and premature ejaculation (PE) are common conditions for which European Association of Urology guidelines lack specific recommendations on penile prosthesis implantation (PPI). Aim To establish expert consensus on the role of PPI in non-organic ED and PE using the Delphi method. Methods A panel of 24 international penile implant surgeons with significant experience in PPI participated in a 3-round Delphi consensus between February and May 2025. Participants were mainly European-based (Italy, n=16; Turkey, n=4; United Kingdom, n=2; Spain, n=1; Germany, n=1). Two online questionnaire rounds were followed by a final virtual meeting. Topics included diagnostics, treatment hierarchy, indications for PPI, ethical concerns, surgical risks, patient satisfaction, partner’s involvement, and follow-up strategies. Consensus was defined as ≥75% agreement or disagreement on Likert-scale items. Outcomes Expert consensus was reached on all 53 items, including the ones regarding the appropriateness of PPI in non-organic ED and PE. Results Experts agreed on the importance of thorough psychosexological assessment, standardized diagnostic tools, and exhausting conservative treatments before considering PPI in non-organic ED. Seventy-five percent supported PPI as a last-resort option in non-organic ED, provided psychological evaluation and informed consent protocols are in place. In contrast, the panel rejected PPI as a treatment for pure PE due to insufficient evidence and lack of clinical experience. Emphasis was placed on ethical safeguards, long-term follow-up, and partner involvement in decision-making. Clinical Implications These findings suggest that, under strict conditions, PPI may have a role in treatment-resistant non-organic ED but not in pure PE. Strengths and Limitations Limitations include the inherent subjectivity of the Delphi methodology and the restricted representativeness of the panel, which was mainly European-based and composed exclusively of urologists specializing in penile implants. Conclusion Selective use of PPI in non-organic ED is supported by expert consensus, while its use in pure PE is not; updated guidelines and further research are warranted.
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