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A Comparative Study of Simultaneous and Delayed Penile Prosthesis During Robot-Assisted Radical Prostatectomy.

Ignacio Moncada1, Pramod Krishnappa1,2, Agustín Fraile-Poblador3,4

  • 1Department of Urology and Robotic Surgery, La Zarzuela University Hospital, Madrid, Spain.

International Journal of Urology : Official Journal of the Japanese Urological Association
|November 21, 2025
PubMed
Summary

Simultaneous penile prosthesis placement during prostatectomy surgery offers superior sexual rehabilitation and better penile length preservation compared to delayed implantation. This approach is safe and enhances patient quality of life without impacting cancer outcomes.

Keywords:
erectile dysfunctionpenile prosthesisprostate cancerradical prostatectomysexual rehabilitation

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Area of Science:

  • Urology
  • Oncology
  • Sexual Medicine

Background:

  • Prostate cancer treatment, particularly radical prostatectomy, often leads to erectile dysfunction (ED).
  • Penile prosthesis (PP) placement is a treatment option for refractory ED.
  • The optimal timing for PP placement relative to robot-assisted radical prostatectomy (RARP) is debated.

Purpose of the Study:

  • To compare sexual rehabilitation outcomes in prostate cancer patients with preexisting ED undergoing simultaneous versus delayed inflatable penile prosthesis (PP) placement during RARP.
  • To assess the impact of timing on patient satisfaction, sexual health, and penile length.
  • To evaluate oncological outcomes and complication rates.

Main Methods:

  • A retrospective study included 56 patients with prostate cancer and refractory ED.
  • Patients underwent either simultaneous RARP and inflatable PP placement (n=29) or RARP followed by delayed PP placement (n=27).
  • Outcomes were assessed at 1 year using Modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), EORTC Sexual Health Scores, and penile length measurements. Oncological outcomes and complications were also reviewed.

Main Results:

  • The simultaneous PP group reported significantly higher Modified EDITS scores (79.1 vs. 61.1) and EORTC Sexual Health scores (62.5 vs. 47.1) at 1 year.
  • Penile length loss was significantly less in the simultaneous group (0.32 cm vs. 1.43 cm).
  • No significant differences were observed in positive surgical margins or biochemical recurrence rates between the groups. No major complications occurred.

Conclusions:

  • Simultaneous inflatable PP placement with RARP is a safe and effective strategy for early sexual rehabilitation in prostate cancer patients with ED.
  • This approach improves patient quality of life and preserves penile length.
  • Oncological control is maintained without compromising surgical outcomes.