Background and Objective: Penile prosthesis implantation (PPI) is the gold-standard treatment for medication-refractory erectile dysfunction (ED). Outcomes are highly surgeon-dependent, yet no published series has described a protocol in which a single surgeon performs every procedural step — from patient preparation and antisepsis through to post-operative activation — without any surgical assistant. We describe this novel protocol and report prospective outcomes for 69 consecutive cases in Dubai, UAE. Methods: Prospective observational cohort study of 69 consecutive patients undergoing three-piece inflatable PPI by a single surgeon at a single center (March 2025 – March 2026). All patients underwent standardized preoperative ultrasound assessment and penile Doppler with intracavernosal injection. The surgeon personally performed all antisepsis steps, device preparation, and post-operative wound care. Results: Mean age was 54.7 ± 14.3 years. Diabetes mellitus 60.9%, hypertension 52.2%, coronary artery disease 39.1%, and antiplatelet therapy at surgery 47.8%. Vasculogenic aetiology accounted for 55.1% of cases. Mean operative time was 119.0 ± 30.0 minutes. Infection rate 4.3% (n=3; all primary cases, all managed conservatively with daily wound dressing and extended antibiotic therapy — no revision surgery required); mechanical failure 0.0%; erosion 0.0%; corporal perforation 2.9% (n=2; all managed intraoperatively); revision surgery 0.0%. Mean patient satisfaction 9.68 ± 0.65/10; partner satisfaction 9.19 ± 0.96/10 (n=63). Mean time to first use 4.4 ± 1.2 weeks. Conclusion: A rigorously standardized single-surgeon PPI protocol — incorporating comprehensive preoperative workup, sequential dual-agent antisepsis, pre-corporotomy reservoir placement, and structured post-operative surveillance — achieves complication rates consistent with international benchmarks and exceptional patient satisfaction in a high-comorbidity population.