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

To compare sexual rehabilitation outcomes in prostate cancer patients with preexisting erectile dysfunction (ED) undergoing simultaneous vs. delayed inflatable penile prosthesis (PP) placement during robot-assisted radical prostatectomy (RARP).

Fifty-six patients with refractory ED and prostate cancer (2011-2023) were included. Simultaneous RARP and inflatable PP placement was done in 29 patients. Twenty-seven patients underwent RARP followed by delayed inflatable PP placement after a mean of 3.28 years. The same surgeon performed both RARP and inflatable PP implantation. Modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), EORTC Sexual Health Scores, and penile length changes were evaluated at 1 year.

Mean age of the simultaneous and delayed PP group was 64.41 and 62.66 years, respectively. The simultaneous group had a higher percentage of severe ED (55.2% vs. 25.9%). At 1 year, simultaneous group patients had significantly better mean Modified EDITS (79.1 vs. 61.1, p < 0.001) and better EORTC Sexual Health scores (62.5 vs. 47.1, p < 0.001). Penile length loss was significantly less in the simultaneous group compared to the delayed group (0.32 ± 0.29 cm vs. 1.43 ± 0.36 cm, p < 0.001). Positive surgical margin (13.7% vs. 18.5%) and biochemical recurrence at 2 years (10.3% vs. 14.8%) showed no significant difference between the simultaneous and delayed PP groups, respectively. No major complications were observed in either group.

Simultaneous inflatable PP with RARP is safe and provides early sexual rehabilitation, improves patients' quality of life and maintains penile length without compromising surgical and oncological outcomes.