{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T20:57:05Z","timestamp":1790542625293,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Gender-affirming inflatable penile prosthesis (IPP) insertion in transgender and gender diverse individuals (TGD) is technically complex and associated with high revision rates. This study is the first to evaluate the effect of cumulative institutional surgical experience on 5-year outcomes after primary IPP insertion and construct institutional outcome-based learning curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was performed using a prospectively maintained institutional database of patients undergoing first-time IPP implantation. The analysis was restricted to patients enrolled until September 2019 to ensure at least 5\u00a0years of follow-up. The primary outcomes were 5-year surgery for any cause and 5-year revision surgery for dissatisfaction. Multivariable logistic regression models and risk-adjusted cumulative sum (RA-CUSUM) analysis were used to identify predictors and learning trajectory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The original cohort included 694 patients. After restricting the analysis to patients with at least 5\u00a0years of follow-up, 473 patients were included: 208 (43.9%) received a Boston Scientific device and 265 (56.1%) received a Coloplast device. Overall, 240 patients (50.7%) had no further surgery within 5\u00a0years. Five-year device survival was higher after RFFF than with other phalloplasty types, with single-cylinder than with two-cylinder implantation, and with Coloplast than with Boston Scientific devices. On multivariable analysis, cumulative institutional surgical experience, Coloplast device use, and single-cylinder implantation were associated with a lower risk of surgery. The probability of surgery for any cause decreased from 65.6% at case 1 to 32.9% at case 473; RA-CUSUM identified peak proficiency at case 311. Revision for dissatisfaction occurred in 104 patients (21.9%). Its rate was higher with Boston Scientific than Coloplast devices, while flap type and cylinder number were not significant. Cumulative institutional surgical experience was the only independent predictor (OR\u2009=\u20090.997, P\u2009=\u2009.020). The probability decreased from 33.2% to 12.8%, with peak proficiency at case 261.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary IPP insertion shows a prolonged learning curve, with progressive improvement in 5-year overall device survival and revision for dissatisfaction as cumulative institutional surgical experience increases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag297","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:55:35Z","timestamp":1790164535000},"source":"Crossref","is-referenced-by-count":0,"title":["Primary gender-affirming inflatable penile prosthesis insertion has a prolonged learning curve"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6065-4418","authenticated-orcid":false,"given":"Andrea","family":"Gobbo","sequence":"first","affiliation":[{"name":"Department of Andrology, New Victoria Hospital , London KT2 7EG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Nim","family":"Christopher","sequence":"additional","affiliation":[{"name":"Department of Andrology, New Victoria Hospital , London KT2 7EG ,","place":["United Kingdom"]},{"name":"St Peter\u2019s Andrology , 54 Beaumont Street, London, W1G 6AA ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Al-Mitwalli","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Sciences, University College London , Gower Street, London, WC1E 6BT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David John","family":"Ralph","sequence":"additional","affiliation":[{"name":"Department of Andrology, New Victoria Hospital , London KT2 7EG ,","place":["United Kingdom"]},{"name":"St Peter\u2019s Andrology , 54 Beaumont Street, London, W1G 6AA ,","place":["United Kingdom"]},{"name":"Division of Surgery and Interventional Sciences, University College London , Gower Street, London, WC1E 6BT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2199-5364","authenticated-orcid":false,"given":"Wai Gin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Andrology, New Victoria Hospital , London KT2 7EG ,","place":["United Kingdom"]},{"name":"St Peter\u2019s Andrology , 54 Beaumont Street, London, W1G 6AA ,","place":["United Kingdom"]},{"name":"Division of Surgery and Interventional Sciences, University College London , Gower Street, London, WC1E 6BT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"issue":"7","key":"2026092716165140200_ref1","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1038\/s41443-023-00764-8","article-title":"Erectile device insertion following phalloplasty in transgender and non-binary individuals assigned female at birth: a narrative review","volume":"35","author":"Chiriaco","year":"2023","journal-title":"Int J Impot Res"},{"issue":"3","key":"2026092716165140200_ref2","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.ucl.2022.04.007","article-title":"Gender affirmation surgery, transmasculine","volume":"49","author":"Lee","year":"2022","journal-title":"Urol Clin North Am"},{"issue":"1","key":"2026092716165140200_ref3","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/bju.14027","article-title":"Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery","volume":"121","author":"Falcone","year":"2018","journal-title":"BJU Int"},{"issue":"4","key":"2026092716165140200_ref4","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.jsxm.2022.01.518","article-title":"Penile prosthesis placement by a dedicated transgender surgery unit: a retrospective analysis of complications","volume":"19","author":"Briles","year":"2022","journal-title":"J Sex Med"},{"issue":"4","key":"2026092716165140200_ref5","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1038\/s41443-025-01137-z","article-title":"The outcomes of inflatable penile prosthesis implantation in the context of genital gender affirming surgery in assigned female At birth patients: a comparative study between cis-male Dacron modified and Zephyr surgical implants 475 female to male penile prosthesis","volume":"38","author":"Falcone","year":"2025","journal-title":"Int J Impot Res"},{"issue":"11","key":"2026092716165140200_ref6","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.jsxm.2016.09.013","article-title":"Surgical outcomes of erectile implants after phalloplasty: retrospective analysis of 95 procedures","volume":"13","author":"Neuville","year":"2016","journal-title":"J Sex Med"},{"key":"2026092716165140200_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16911","article-title":"Hydraulic and malleable female-to-male penile implants after phalloplasty in transgender individuals: a retrospective cohort analysis","author":"Levy","year":"2025","journal-title":"BJU Int"},{"key":"2026092716165140200_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/bju.70258","article-title":"Long-term outcomes for mechanical failure and revision following primary gender-affirming penile prosthesis insertion","author":"Lee","year":"2026","journal-title":"BJU Int"},{"issue":"12","key":"2026092716165140200_ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta5120","article-title":"Statistical assessment of the learning curves of health technologies","volume":"5","author":"Ramsay","year":"2001","journal-title":"Health Technol Assess"},{"issue":"1115","key":"2026092716165140200_ref10","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1136\/postgradmedj-2018-135880","article-title":"Learning curves in surgery: variables, analysis and applications","volume":"94","author":"Valsamis","year":"2018","journal-title":"Postgrad Med J"},{"issue":"22","key":"2026092716165140200_ref11","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMsa035205","article-title":"Surgeon volume and operative mortality in the United States","volume":"349","author":"Birkmeyer","year":"2003","journal-title":"N Engl J Med"},{"issue":"3","key":"2026092716165140200_ref12","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.eururo.2013.10.030","article-title":"Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases","volume":"65","author":"Thompson","year":"2014","journal-title":"Eur Urol"},{"issue":"2","key":"2026092716165140200_ref13","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.eururo.2019.12.008","article-title":"Learning curve in robot-assisted kidney transplantation: results from the European robotic urological society working group","volume":"78","author":"Gallioli","year":"2020","journal-title":"Eur Urol"},{"issue":"3","key":"2026092716165140200_ref14","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.eururo.2013.11.034","article-title":"What are the implications of the surgical learning curve?","volume":"65","author":"Vickers","year":"2014","journal-title":"Eur Urol"},{"issue":"2","key":"2026092716165140200_ref15","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/bju.14462","article-title":"Satisfaction rate at 1-year follow-up in patients treated with penile implants: data from the multicentre prospective registry INSIST-ED","volume":"123","author":"Capogrosso","year":"2019","journal-title":"BJU Int"},{"issue":"3","key":"2026092716165140200_ref16","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1016\/j.euf.2021.05.003","article-title":"Global trends in prevalence, treatments, and costs of penile prosthesis for erectile dysfunction in men","volume":"8","author":"Kohn","year":"2022","journal-title":"Eur Urol Focus"},{"issue":"1","key":"2026092716165140200_ref17","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s11934-026-01324-5","article-title":"Cost considerations in penile implant surgery from a global perspective","volume":"27","author":"Black","year":"2026","journal-title":"Curr Urol Rep"},{"key":"2026092716165140200_ref18","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1136\/bmj.304.6838.1359","article-title":"Quality control: an application of the cusum","volume":"304","author":"Williams","year":"1992","journal-title":"BMJ"},{"issue":"2","key":"2026092716165140200_ref19","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.eururo.2009.03.013","article-title":"Erectile implants in female-to-male transsexuals: our experience in 129 patients","volume":"57","author":"Hoebeke","year":"2010","journal-title":"Eur Urol"},{"key":"2026092716165140200_ref20","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1038\/s41443-025-01161-z","article-title":"Sexual and urological reconstruction following penectomy for penile cancer: phalloplasty","volume":"37","author":"Gobbo","year":"2025","journal-title":"Int J Impot Res"},{"key":"2026092716165140200_ref21","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.euros.2022.12.007","article-title":"The learning curve for radical nephrectomy for kidney cancer: implications for surgical training","volume":"49","author":"Larcher","year":"2023","journal-title":"Eur Urol Open Sci"},{"issue":"1","key":"2026092716165140200_ref22","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1007\/s00345-025-05974-x","article-title":"Evaluating the learning curve for single-port radical prostatectomy: a multi-institutional cohort analysis","volume":"43","author":"Finocchiaro","year":"2025","journal-title":"World J Urol"},{"key":"2026092716165140200_ref23","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.eururo.2022.01.004","article-title":"Proficiency-based progression training: a scientific approach to learning surgical skills","volume":"81","author":"Gallagher","year":"2022","journal-title":"Eur Urol"},{"issue":"2","key":"2026092716165140200_ref24","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1097\/SLA.0000000000004650","article-title":"A systematic review and meta-analysis on the impact of proficiency-based progression simulation training on performance outcomes","volume":"274","author":"Mazzone","year":"2021","journal-title":"Ann Surg"},{"key":"2026092716165140200_ref25","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1002\/bjs.9482","article-title":"Systematic review of skills transfer after surgical simulation-based training","volume":"101","author":"Dawe","year":"2014","journal-title":"Br J Surg"},{"issue":"5","key":"2026092716165140200_ref26","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/j.eururo.2018.12.044","article-title":"Utilising the Delphi process to develop a proficiency-based progression train-the-trainer course for robotic surgery training","volume":"75","author":"Collins","year":"2019","journal-title":"Eur Urol"},{"issue":"2","key":"2026092716165140200_ref27","doi-asserted-by":"publisher","DOI":"10.1093\/jsxmed\/qdaf365","article-title":"Penile implants after phalloplasty in transgender individuals: a consensus-based surgical clinical protocol concerning pre-, peri-, and postoperative care","volume":"23","author":"Levy","year":"2026","journal-title":"J Sex Med"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/10\/qdag297\/71405037\/qdag297.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/10\/qdag297\/71405037\/qdag297.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T20:16:56Z","timestamp":1790540216000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdag297\/8836774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,14]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdag297","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,14]]},"article-number":"qdag297"}}