{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:24:48Z","timestamp":1787145888058,"version":"build-2736575974"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Impot Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Inflatable penile prosthesis configuration remains highly variable among surgeons, with decisions often guided by individual experience rather than standardized criteria. We evaluated agreement between the Canguven Penile Prosthesis Calculator (an anatomy-based decision-support tool) and experienced penile prosthesis surgeons to characterize inter-surgeon variability using a standardized virtual-case model. A total of 60 cases were constructed incorporating total corporal length, proximal corporal length, scrotal size, and predefined prosthesis model (AMS 700 CX\u2122, Boston Scientific Corporation, Marlborough, MA, USA; Titan\u2122, Coloplast Corporation, Minneapolis MN, USA; and Infla10\u2122, Rigicon Inc., Ronkonkoma, NY, USA). A total of 7 experienced penile prosthesis surgeons from 6 institutions independently evaluated the cases, blinded to calculator recommendations, and selected cylinder length, rear-tip extender, and reservoir volume, generating 340 surgeon-case decisions. Agreement was assessed using exact agreement, clinically acceptable agreement (\u00b11 cylinder size), and kappa statistics. Exact agreement between calculator recommendations and surgeon-selected cylinder length was observed in 198 of 340 decisions (58.2%), increasing to 302 of 340 decisions (88.8%) within a clinically acceptable range. The mean absolute difference was 0.95\u2009\u00b1\u20091.18\u2009cm, with discrepancies greater than 2\u2009cm observed in 38 of 340 decisions (11.2%). Inter-rater agreement was moderate (Fleiss\u2019 \u03ba\u2009=\u20090.46, 95% CI 0.41\u20130.51), and pairwise agreement between the calculator and individual surgeons ranged from \u03ba\u2009=\u20090.43 to 0.55. Reservoir selection demonstrated excellent agreement (329\/340 decisions, 96.8%). Variability in prosthesis configuration decisions was primarily driven by differences in rear-tip extender utilization, reflecting consistent but distinct surgeon-specific strategies. Inflatable penile prosthesis configuration demonstrates substantial variability among experienced surgeons, although most differences fall within clinically acceptable limits. The anatomy-based algorithm demonstrated moderate agreement with expert surgeon selections and may provide a structured, anatomy-based framework for prosthesis configuration planning while preserving individualized surgical decision-making.<\/jats:p>","DOI":"10.1038\/s41443-026-01346-0","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:37:43Z","timestamp":1787143063000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Agreement between an anatomy-based inflatable penile prosthesis configuration algorithm and expert surgeon decision-making: a virtual case study"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1010-0609","authenticated-orcid":false,"given":"Onder","family":"Canguven","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Al Kubaisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"El-achkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0551-9536","authenticated-orcid":false,"given":"Ahmed","family":"Ragheb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6184-8801","authenticated-orcid":false,"given":"Orhan","family":"Koca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-5623","authenticated-orcid":false,"given":"Fernando Nestor","family":"Facio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2530-7012","authenticated-orcid":false,"given":"Ege Can","family":"Serefoglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"1346_CR1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.eururo.2025.04.010","volume":"88","author":"A Salonia","year":"2025","unstructured":"Salonia A, Capogrosso P, Boeri L, Cocci A, Corona G, Dinkelman-Smit M, et al. European association of urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie\u2019s disease. Eur Urol. 2025;88:76\u2013102.","journal-title":"Eur Urol"},{"key":"1346_CR2","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1038\/s41585-022-00607-z","volume":"19","author":"E Chung","year":"2022","unstructured":"Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, et al. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol. 2022;19:534\u201346.","journal-title":"Nat Rev Urol"},{"key":"1346_CR3","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1038\/s41443-025-01030-9","volume":"37","author":"A Vural","year":"2025","unstructured":"Vural A, De Bruyn H, Van Renterghem K. How to improve functional outcome of inflatable penile implant surgery? a narrative review. Int J Impot Res. 2025;37:873\u201380.","journal-title":"Int J Impot Res"},{"key":"1346_CR4","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1038\/s41443-021-00431-w","volume":"34","author":"K van Renterghem","year":"2022","unstructured":"van Renterghem K, Jacobs B, Yafi F, Osmonov D, Ralph D, Venturino L, et al. Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study. Int J Impot Res. 2022;34:302\u20137.","journal-title":"Int J Impot Res"},{"key":"1346_CR5","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/SLA.0000000000002693","volume":"268","author":"DA Hashimoto","year":"2018","unstructured":"Hashimoto DA, Rosman G, Rus D, Meireles OR. Artificial intelligence in surgery: promises and perils. 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J Sex Med. 2013;10:309\u201312.","journal-title":"J Sex Med"},{"key":"1346_CR9","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.jsxm.2019.04.013","volume":"16","author":"S Cayan","year":"2019","unstructured":"Cayan S, Asci R, Efesoy O, Bolat MS, Akbay E, Yaman O. Comparison of long-term results and couples\u2019 satisfaction with penile implant types and brands: lessons learned from 883 patients with erectile dysfunction who underwent penile prosthesis implantation. J Sex Med. 2019;16:1092\u20139.","journal-title":"J Sex Med"},{"key":"1346_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-020-01027-5","volume":"22","author":"RE Fernandez-Crespo","year":"2021","unstructured":"Fernandez-Crespo RE, Buscaino K, Carrion R. \u201cPumpology\u201d: the realistic issues associated with pump placement in prosthetic surgery. 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Indications for penile prosthesis revision: lessons learned to limit technical causes of reoperation. J Sex Med. 2019;16:1444\u201350.","journal-title":"J Sex Med"}],"container-title":["International Journal of Impotence Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41443-026-01346-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41443-026-01346-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41443-026-01346-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:37:44Z","timestamp":1787143064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41443-026-01346-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":20,"alternative-id":["1346"],"URL":"https:\/\/doi.org\/10.1038\/s41443-026-01346-0","relation":{},"ISSN":["0955-9930","1476-5489"],"issn-type":[{"value":"0955-9930","type":"print"},{"value":"1476-5489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"assertion":[{"value":"23 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"ECS is the Editor-in-Chief of Int J Impot Res and he received travel grants from Boston Scientific, Coloplast and Rigicon. Other authors declare that they have no financial or non-financial conflicts of interest related to this study.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The study utilized anonymized virtual-case scenarios and did not involve direct patient participation. The study protocol was approved by the Institutional Review Board (MRC-01-25-1481), which waived the requirement for informed consent. All methods were performed in accordance with the relevant guidelines and regulations.","order":2,"name":"Ethics","label":"Ethics","group":{"name":"EthicsHeading","label":"Ethics"}}]}}