Penile implant surgery after prostate cancer

Erectile dysfunction is one of the most common lasting effects of prostate cancer treatment, whether that treatment was surgery, radiotherapy or hormonal therapy. For men in whom it does not recover with time and non-surgical treatment, a penile implant is an established option.

Why it happens

• Radical prostatectomy can injure or require removal of the nerves that run alongside the prostate and carry the signals for erection.
• Radiotherapy affects the blood vessels and tissue of the erectile bodies over months to years, so erectile function can decline gradually after treatment.
• Hormonal therapy reduces testosterone, which affects libido as well as erectile function.

What is usually tried first

Tablets, injection therapy, a vacuum device, and time — nerve recovery after nerve-sparing surgery can continue for up to two years. An implant is normally considered once those options have been tried and are insufficient, or where nerve injury makes recovery unlikely.

What is different about implant surgery in this group

• Previous pelvic surgery changes the anatomy, and reservoir placement needs specific planning. Low-profile reservoirs and alternative placement sites exist for this reason.
• Radiotherapy affects tissue quality and healing, which is taken into account in planning and in the expected recovery.
• Ejaculation is absent after radical prostatectomy and the implant does not restore it. Orgasm is generally still possible.
• Some men have both erectile dysfunction and urinary incontinence; where both are treated, the sequencing is discussed explicitly.
• Perceived shortening is more common in this group, particularly where there has been a long interval since treatment.

What your surgeon needs to know

• The type and date of your cancer treatment, and your operation note if you had surgery.
• Your current PSA and oncological follow-up status.
• Whether you had radiotherapy, and to which fields.
• Whether you are on or have had hormonal therapy.
• Any urinary symptoms, incontinence, or previous continence surgery.