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Background Extended reality-assisted urologic surgery (XRAS) is a novel technology that superimposes a computer-generated image on the physician’s field to integrate common elements of the surgical process in more advanced detail. An extended reality (XR) interface is generated using optical head-mounted display (OHMD) devices. Aim To present the first case of HoloLens-assisted complex penile revision surgery. Methods We describe our pilot study of HoloLens-assisted penile revision surgery and present a thorough review of the literature regarding XRAS technology and innovative OHMD devices. Outcomes The ability of XRAS technology to superimpose a computer-generated image of the patient and integrate common elements of the surgical planning process with long-distance experts. Results XRAS is a feasible technology for application in complex penile surgical planning processes. Clinical Translation XRAS and OHMD devices are novel technologies applicable to urological surgical training and planning. Strengths and Limitations Evidence suggests that the potential use of OHMD devices is safe and beneficial for surgeons. We intend to pioneer HoloLens technology in the surgical planning process of a malfunctioning penile implant due to herniation of the cylinder. This novel technology has not been used in prosthetic surgery, and current data about XRAS are limited. Conclusion OHMD devices are effective in the operative setting. Herein, we successfully demonstrated the integration of Microsoft HoloLens 2 into a penile surgical planning process for the first time. Further development and studies for this technology are necessary to better characterize the XRAS as a training and surgical planning tool.

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