Managing Robotic Radical Prostatectomy in Men with Penile Prosthesis: Surgical Tech-nique, Outcomes, and Literature...

Robotic-assisted radical prostatectomy (RARP) in patients with pre-existing inflatable penile prostheses (IPP) poses technical challenges due to the intrapelvic reservoir. With rising rates of prostate cancer and IPP use, evidence on safely performing RARP in this group is limited. This study assesses the feasibility, safety, and perioperative outcomes of RARP in men with prior IPP.

We retrospectively analyzed 32 prostate cancer patients with functional three-piece IPPs who underwent RARP (2016-2024), excluding those with prior pelvic radiation, malleable implants, or incomplete data. Key adaptations included tailored port placement, cold dissection near the reservoir, site-specific retraction without reservoir removal, and intraoperative deflation as needed. Perioperative, functional, and oncologic outcomes were systematically assessed.

Median age was 67 years (IQR 61-73). Follow up duration was 24 months from RARP. Median operative time and blood loss were 110 minutes (IQR 98-120) and 100 mL (IQR 50-120), respectively. No intraoperative prosthesis injuries occurred. Clavien-Dindo grade I-II complications were observed in 8 patients (25%). Median time to continence (≤1 pad/day) was 56 days (IQR 46-92). All IPPs remained functional postoperatively without revision. 31 patients were continent at 12 months. Pathologic pT2 disease was present in 16 (50%) patients; positive margins occurred in 4 (12.5%) patients. Biochemical recurrence was noted in 9.4% at 12-month median follow-up.

RARP in patients with a pre-existing penile prosthesis reservoir is technically feasible and safe, with no increase in procedure-related or reservoir-specific complications.