Erectile Function and Sexual Satisfaction Before and After Penile Prosthesis Implantation in Radical Prostatectomy Patients: A Comparison with Patients with Vasculogenic Erectile Dysfunction

Abstract

Introduction Patients with erectile dysfunction (ED) after radical prostatectomy (RP) may benefit from penile prosthesis (PP) implantation after failure of less invasive treatments. Aim To assess surgical outcomes and satisfaction after PP implantation in RP patients and compare the results with those in patients with vasculogenic ED (controls). Methods A database of 415 consecutive PPs (January 1996–December 2008) was used to collate data on preimplantation ED treatments, surgical complications, satisfaction, and International Index of Erectile Function (IIEF) scores before and 3 months after implantation. The results for 90 post-RP implants (79 primary, 11 secondary) and 131 implants for vasculogenic ED were compared. Main Outcome Measures The main outcome measures of this study are intra- and postoperative complications and IIEF domain scores. Results Mean follow-up of RP patients was 37.6 ± 26.8 months. Mean interval between RP and PP implantation was 31.5 ± 28.7 months. Nearly all primary implants (96.2%) were inflatable (3-piece, 70.1%; 2-piece, 24.1%). There was no significant difference between groups in terms of rates of infection (1.1%), mechanical failure (3.3%), and other surgical complications requiring revision surgery (migration, auto-inflation) (4.4%). For primary implants, the mean preimplantation IIEF score (all items) was significantly lower in RP patients than in controls (14.7 ± 5.9 vs. 22.6 ± 10.8, P = 0.003), chiefly because of significantly lower scores for erectile function, intercourse satisfaction, and orgasmic function. After PP implantation in RP patients, the scores for all domains improved, but the total score remained significantly lower than in controls (63.1 ± 7.0 vs. 68.5 ± 6.9, P = 0.005). The orgasmic function score was significantly lower (P < 0.001). Overall satisfaction rate was 86.1% in RP patients and 90.7% in controls (P = 0.3). Conclusions PP implantation after RP is associated with low morbidity and high satisfaction. It improves the scores for all IIEF domains and, in particular, erectile function. Fibrosis of the retropubic space may require a second incision for reservoir placement or implantation of a 2-piece PP.

Prediction model for penile prosthesis implantation for erectile dysfunction management

“…This delay seems surprising given the likely waning of the taboo associated with openly discussing ED, as well as the explosion of direct-to-consumer advertising for ED treatments in both electronic and print media 25 . In another study comprising a cohort of men who underwent PPI, the mean duration of ED prior to surgery was 60 months 23 . All of these patients had previously tried at least one other ED treatment, which conceivably proved unsuccessful enough to warrant PP surgery.…”

“…The time period between onset of ED symptoms and PP implantation (PPI) is variable, and may cover an extended time period 22,23 . During this time, the patient may experience diminished quality of life, including role limitation due to physical and emotional problems, negative perceptions of health, and relationship hardship.…”

Post-prostatectomy erectile dysfunction: contemporary approaches from a US perspective

“…A study by Menard et al examined a database of over 400 patients and showed penile prosthesis placement after radical prostatectomy has a complication rate of less than 5% for infection, revision, or mechanical failure, as well as an overall satisfaction rate of 86.1% 55. Furthermore, in this study, patients with post-radical prostatectomy and a penile prosthesis were compared with patients with vasculogenic erectile dysfunction and a penile prosthesis 55.…”

“…Furthermore, in this study, patients with post-radical prostatectomy and a penile prosthesis were compared with patients with vasculogenic erectile dysfunction and a penile prosthesis 55. There were no significant differences with respect to surgical complications, mechanical failure, or infections.…”

Postprostatectomy Erectile Dysfunction: A Review

“…Indeed, patients undergoing NNS surgery for PCa, but still desiring a sexually active life, may benefit from penile prostheses after the failure of other treatment modalities [82]. However, despite numerous demonstrations of an excellent efficacy profile and high satisfaction rates in up to 98% of implanted patients and 96% of patients' partners [929394], penile prostheses are currently underused in the setting of post-RP ED. Tal et al [95], for instance, reported data from the Surveillance Epidemiology and End Results cancer registry, showing that only 0.78% of patients treated with either RP or radiation therapy eventually received a penile implant.…”