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Simultaneous penile prothesis implantation during radical prostatectomy in patients with localized prostate cancer and erectile dysfunction

https://doi.org/10.21886/2308-6424-2026-14-3-94-104

Abstract

Introduction. Prostate cancer (PCa) is one of the most common malignancies in middle-aged and older men, ranking second in incidence and sixth in cancer-related mortality worldwide. Among radical treatment options for localised PCa, radical prostatectomy (RP) remains the preferred approach.

Objective. To review the current literature on simultaneous penile prosthesis implantation at the time of radical prostatectomy in patients with localised prostate cancer and erectile dysfunction (ED).

Materials and methods. A systematic literature search was performed using both international and Russian databases, including Medline, Scopus, Web of Science, PubMed, and eLibrary, to identify rel-evant studies for this review.

Results. The review focused on three key aspects: (1) the pathogenesis of erectile dysfunction follow-ing radical prostatectomy; (2) contemporary management strategies for post-prostatectomy ED; and (3) the rationale, techniques, and outcomes of simultaneous penile prosthesis implantation during radical prostatectomy in patients with concomitant PCa and ED.

Conclusion. Simultaneous penile prosthesis implantation at the time of radical prostatectomy may rep-resent a preferred option in patients for whom nerve-sparing techniques are contraindicated for onco-logical reasons, offering an effective and safe approach to restoring erectile function. This strategy may also be particularly beneficial in highly motivated patients seeking to preserve penile length.

About the Authors

M. V. Shamin
Podgorbunsky Kuzbass Clinical Hospital of Emergency Medical Care
Russian Federation

Mikhail V. Shamin

Kemerovo



P. S. Kyzlasov
State Research Centre of the Russian Federation — Burnazyan Federal Medical Biophysical Centre; Bashkir State Medical University
Russian Federation

Pavel S. Kyzlasov —Dr.Sc.(Med), Full Prof.

Moscow, Ufa



I. V. Kuzmin
Pavlov First Saint Petersburg State Medical University
Russian Federation

Igor V. Kuzmin — Dr.Sc.(Med), Full Prof.

Saint Petersburg



A. I. Bragin-Maltsev
Podgorbunsky Kuzbass Clinical Hospital of Emergency Medical Care
Russian Federation

Andrey I. Bragin-Maltsev

Kemerovo



E. V. Volokitin
Podgorbunsky Kuzbass Clinical Hospital of Emergency Medical Care
Russian Federation

Evgeny E. Volokitin

Kemerovo



A. K. Gural
Tomsk Regional Oncological Dispensary
Russian Federation

Andrey K. Gural

Tomsk



References

1. Arnold M., Karim-Kos H.E., Coebergh J.W., Byrnes G., Antilla A., Ferlay J., Renehan A.G., Forman D., Soerjomataram I. Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory. Eur J Cancer. 2015;51(9):1164-1187. DOI: 10.1016/j.ejca.2013.09.002

2. Center M.M., Jemal A., Lortet-Tieulent J., Ward E., Ferlay J., Brawley O., Bray F. International variation in prostate cancer incidence and mortality rates. Eur Urol. 2012;61(6):1079-1092. DOI: 10.1016/j.eururo.2012.02.054

3. Sanda M.G., Dunn R.L., Michalski J., Sandler H.M., Northouse L., Hembroff L., Lin X., Greenfield T.K., Litwin M.S., Saigal C.S., Mahadevan A., Klein E., Kibel A., Pisters L.L., Kuban D., Kaplan I., Wood D., Ciezki J., Shah N., Wei J.T. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250-1261. DOI: 10.1056/NEJMoa074311

4. Bill-Axelson A., Holmberg L., Filén F., Ruutu M., Garmo H., Busch C., Nordling S., Häggman M., Andersson S.O., Bratell S., Spångberg A., Palmgren J., Adami H.O., Johansson J.E.; Scandinavian Prostate Cancer Group Study Number 4. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst. 2008;100(16):1144-1154. DOI: 10.1093/jnci/djn255

5. Adolfsson J. Watchful waiting and active surveillance: the current position. BJU Int. 2008;102(1):10-14. DOI: 10.1111/j.1464-410X.2008.07585.x

6. Heidenreich A., Bastian P.J., Bellmunt J., Bolla M., Joniau S., van der Kwast T., Mason M., Matveev V., Wiegel T., Zattoni F., Mottet N.; European Association of Urology. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124-137. DOI: 10.1016/j.eururo.2013.09.046

7. Bill-Axelson A., Holmberg L., Garmo H., Rider J.R., Taari K., Busch C., Nordling S., Häggman M., Andersson S.O., Spångberg A., Andrén O., Palmgren J., Steineck G., Adami H.O., Johansson J.E. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370(10):932-942. DOI: 10.1056/NEJMoa1311593

8. Wang X., Wu Y., Guo J., Chen H., Weng X., Liu X. Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies. BMC Urol. 2019;19(41). DOI: 10.1186/s12894-019-0476-2

9. Steineck G., Bjartell A., Hugosson J., Axén E., Carlsson S., Stranne J., Wallerstedt A., Persson J., Wilderäng U., Thorsteinsdottir T., Gustafsson O., Lagerkvist M., Jiborn T., Haglind E., Wiklund P.; LAPPRO steering committee. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol. 2015;67(3):559-568. DOI: 10.1016/j.eururo.2014.10.011

10. Tewari A.K., Srivastava A., Huang M.W., Robinson B.D., Shevchuk M.M., Durand M., Sooriakumaran P., Grover S., Yadav R., Mishra N., Mohan S., Brooks D.C., Shaikh N., Khanna A., Leung R. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int. 2011;108(6 Pt 2):984-992. DOI: 10.1111/j.1464-410X.2011.10565.x

11. Stolzenburg J.U., Kallidonis P., Minh D., Dietel A., Häfner T., Rabenalt R., Sakellaropoulos G., Ganzer R., Paasch U., Horn L.C., Liatsikos E. A comparison of outcomes for interfascial and intrafascial nerve-sparing radical prostatectomy. Urology. 2010;76(3):743-748. DOI: 10.1016/j.urology.2010.03.089

12. Catalona W.J., Bigg S.W. Nerve-sparing radical prostatectomy: evalua tion of results after 250 patients. J Urol. 1990;143(3):538-543; discussion 544. DOI: 10.1016/s0022-5347(17)40013-9

13. Neill M.G., Louie-Johnsun M., Chabert C., Eden C. Does intrafascial dissection during nerve-sparing laparoscopic radical prostatectomy compromise cancer control? BJU Int. 2009;104(11):1730-1733. DOI: 10.1111/j.1464-410x.2009.08670.x

14. Ward J.F., Zincke H., Bergstralh E.J., Slezak J.M., Myers R.P., Blute M.L. The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol. 2004;172(4 Pt 1):1328-1332. DOI: 10.1097/01.ju.0000138681.64035.dc

15. Ficarra V., Novara G., Galfano A., Stringari C., Baldassarre R., Cavalleri S., Artibani W. Twelve-month self-reported quality of life after retropubic radical prostatectomy: a prospective study with Rand 36-Item Health Survey (Short Form-36). BJU Int. 2006;97(2):274-278. DOI: 10.1111/j.1464-410X.2005.05893.x

16. Davison B.J., So A.I., Goldenberg S.L. Quality of life, sexual function and decisional regret at 1 year after surgical treatment for localized prostate cancer. BJU Int. 2007;100(4):780-785. DOI: 10.1111/j.1464-410X.2007.07043.x

17. Rakul S.A., Petrov S.B., Ivanova M.D., Petrova N.N. Appraisal of a universal quality of life questionnaire for patients with prostate cancer. Onkourologiya. 2009;(2):64-74. (In Russian). eLIBRARY ID: 15101022; EDN: MSLVXJ

18. Briganti A., Gallina A., Suardi N., Capitanio U., Tutolo M., Bianchi M., Passoni N., Salonia A., Colombo R., Di Girolamo V., Guazzoni G., Rigatti P., Montorsi F. Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med. 2010;7(7):2521-2531. DOI: 10.1111/j.1743-6109.2010.01845.x

19. Osadchinskii A.E., Pavlov I.S., Kotov S.V. Penile rehabilitation in patients after radical prostatectomy. Experimental and Clinical Urology. 2021;14(3):73-79. (In Russian). DOI: 10.29188/2222-8543-2021-14-3-73-79

20. Lin H., Wang G., Wang R. Vacuum erectile device for penile rehabilitation. J Integr Nephrol Androl. 2014;1(1):4-10. DOI: 10.4103/2225-1243.137541.

21. Qian S.Q., Gao L., Wei Q., Yuan J. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence. Asian J Androl. 2016;18(3):446-451. DOI: 10.4103/1008-682X.159716

22. Hoyland K., Vasdev N., Adshead J. The use of vacuum erection devices in erectile dysfunction after radical prostatectomy. Rev Urol. 2013;15(2):67-71. PMID: 24082845; PMCID: PMC3784970

23. Petrovskii N.V., Glybochko P.V., Alyaev Yu.G., Amosov A.V., Krupinov G.E. Local recurrence of prostate cancer after radical prostatectomy. Urologiia. 2017;(4):85-90. (In Russian). DOI: 10.18565/urol.2017.4.85-90

24. Karnaukh P.A., Jaitcev S.V., Vazhenin A.V., Zolotykh M.A., Peretruhin A.A. Prevention and treatment of erectile dysfunction in patients after radical nervesparing prostatectomy. Urology Herald. 2015;(4):50-64. (In Russian). DOI: 10.21886/2308-6424-2015-0-4-50-64

25. Chung E., Gillman M. Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust. 2014;200(10):582-585. DOI: 10.5694/mja13.11028

26. Savoie M., Kim S.S., Soloway M.S. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J Urol. 2003;169(4):1462-1464. DOI: 10.1097/01.ju.0000053720.93303.33

27. McCullough A. Penile change following radical prostatectomy: size, smooth muscle atrophy, and curve. Curr Urol Rep. 2008;9(6):492-499. DOI: 10.1007/s11934-008-0084-2

28. Gontero P., Galzerano M., Bartoletti R., Magnani C., Tizzani A., Frea B., Mondaini N. New insights into the pathogenesis of penile shortening after radical prostatectomy and the role of postoperative sexual function. J Urol. 2007;178(2):602-607. DOI: 10.1016/j.juro.2007.03.119

29. Shamin M.V., Kyzlasov P.S., Pomeshkin E.V., Neymark B.A., Pogosyan R.R., Sergeyev V.P., Zabelin M.V. Possibilities of combined treatment aimed at preservation of sexual function in patients after radical prostatectomy due to localized prostate cancer. Experimental and Clinical Urology. 2016;(4):86-91. (In Russian). eLIBRARY ID: 28870142; EDN: YHTXCT

30. Kyzlasov P.S., Sokolshchik M.M., Paklina O.V., Martov A.G., Setdikova G.R., Topuzov T.M., Grin E.A., Orlov I.N. Histological substantiation of terms of phalloendoprosthesis after radical prostatectomy. Experimental and Clinical Urology. 2017;(2):34-38. (In Russian). eLIBRARY ID: 29899577; EDN: ZEHPLH

31. Briganti A., Fabbri F., Salonia A., Gallina A., Chun F.K., Dehò F., Zanni G., Suardi N., Karakiewicz P.I., Rigatti P., Montorsi F. Preserved postoperative penile size correlates well with maintained erectile function after bilateral nerve-sparing radical retropubic prostatectomy. Eur Urol. 2007;52(3):702-707. DOI: 10.1016/j.eururo.2007.03.050

32. Mulhall J.P., Bella A.J., Briganti A., McCullough A., Brock G. Erectile function rehabilitation in the radical prostatectomy patient. J Sex Med. 2010;7(4 Pt 2):1687-1698. DOI: 10.1111/j.1743-6109.2010.01804.x

33. Veliyev E.I., Vanin A.F., Kotov S.V., Shishlo V.K. Modern aspects of pathophysiology and prevention of erectile dysfunction and cavernous fibrosis after radical prostatectomy. Urologiia. 2009;(2):46-51. (In Russian). eLIBRARY ID: 12869860; EDN: KVQKOD

34. Mazo E.B., Gamidov S.I., Ovchinnikov R.I., Iremashvili V.V. Novye aspekty patogeneza, profilaktiki i lecheniya ehrektil’noi disfunktsii u bol’nykh posle radikal’noi prostatehktomii. Consilium medicum. 2004;6(7):506- 509. (In Russian). eLIBRARY ID: 26566922; EDN: WJJLUX

35. Salonia A., Burnett A.L., Graefen M., Hatzimouratidis K., Montorsi F., Mulhall J.P., Stief C. Prevention and management of postprostatectomy sexual dysfunctions part 2: recovery and preservation of erectile function, sexual desire, and orgasmic function. Eur Urol. 2012;62(2):273- 286. DOI: 10.1016/j.eururo.2012.04.047

36. Babintsev A.V., Borisov P.S., Rakul S.A. Treatment of erectile dysfunction in patients with prostate tumor after radical prostatectomy. Andrology and Genital Surgery. 2017;18(1):80-86. (In Russian). DOI: 10.17650/2070-9781-2017-18-1-80-86

37. Hatzimouratidis K., Amar E., Eardley I., Giuliano F., Hatzichristou D., Montorsi F., Vardi Y., Wespes E.; European Association of Urology. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804-814. DOI: 10.1016/j.eururo.2010.02.020

38. Montorsi F., McCullough A. Efficacy of sildenafil citrate in men with erectile dysfunction following radical prostatectomy: a systematic review of clinical data. J Sex Med. 2005;2(5):658-667. DOI: 10.1111/j.1743-6109.2005.00117.x

39. Wang X., Wang X., Liu T., He Q., Wang Y., Zhang X. Systematic review and meta-analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve-sparing radical prostatectomy. PLoS One. 2014;9(3):e91327. DOI: 10.1371/journal.pone.0091327

40. Eardley I., Donatucci C., Corbin J., El-Meliegy A., Hatzimouratidis K., McVary K., Munarriz R., Lee S.W. Pharmacotherapy for erectile dysfunction. J Sex Med. 2010;7(1 Pt 2):524-540. DOI: 10.1111/j.1743-6109.2009.01627.x

41. Porst H., Burnett A., Brock G., Ghanem H., Giuliano F., Glina S., Hellstrom W., Martin-Morales A., Salonia A., Sharlip I.; ISSM Standards Committee for Sexual Medicine. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med. 2013;10(1):130- 171. DOI: 10.1111/jsm.12023

42. Vardi Y., Sprecher E., Gruenwald I. Logistic regression and survival analysis of 450 impotent patients treated with injection therapy: longterm dropout parameters. J Urol. 2000;163(2):467-470. PMID: 10647656

43. Heidenreich A., Aus G., Bolla M., Joniau S., Matveev V.B., Schmid H.P., Zattoni F.; European Association of Urology. EAU guidelines on prostate cancer. Eur Urol. 2008;53(1):68-80. DOI: 10.1016/j.eururo.2007.09.002

44. Wilson S.K., Delk J.R., Salem E.A., Cleves M.A. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med. 2007;4(4 Pt 1):1074-1079. DOI: 10.1111/j.1743-6109.2007.00540.x

45. Cocci A., Cito G., Romano A., Larganà G., Vignolini G., Minervini A., Di Maida F., Campi R., Carini M., Mondaini N., Russo G.I. Radical prostatectomy and simultaneous penile prosthesis implantation: a narrative review. Int J Impot Res. 2020;32(3):274-280. DOI: 10.1038/s41443-019-0176-1

46. Khoudary K.P., DeWolf W.C., Bruning C.O. 3rd, Morgentaler A. Immediate sexual rehabilitation by simultaneous placement of penile prosthesis in patients undergoing radical prostatectomy: initial results in 50 patients. Urology. 1997;50(3):395-399. DOI: 10.1016/S0090-4295(97)00280-X

47. Ramsawh H.J., Morgentaler A., Covino N., Barlow D.H., DeWolf W.C. Quality of life following simultaneous placement of penile prosthesis with radical prostatectomy. J Urol. 2005;174(4 Pt 1):1395-1398. DOI: 10.1097/01.ju.0000173939.86858.d6

48. Mondaini N., Cai T., Sarti E., Polloni G., Gavazzi A., Conti D., Cocci A., Albersen M., Cito G., Bartoletti R. A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation. World J Mens Health. 2018;36(2):132-138. DOI: 10.5534/wjmh.17043

49. Mondaini N., Sarti E., Giubilei G., Gavazzi A., Costanzi A., Belba A., Cai T., Bartoletti R. Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era. Arch Ital Urol Androl. 2014;86(3):161-163. DOI: 10.4081/aiua.2014.3.161

50. Ceruti C., Sedigh O., Timpano M., Sibona M., Falcone M., Preto M., Oderda M., Gontero P., Frea B., Rolle L. Treatment of prostate cancer and sexual rehabilitation when a nerve-sparing procedure is not feasible: Placement of the reservoir for a three-component penile implant during robotic extra-aponeurotic radical prostatectomy. J Sex Med. 2016;13(S2):S149. DOI: 10.1016/j.jsxm.2016.03.179

51. Glybochko P.V., Matyukhov I.P., Alyayev Yu.G., Akhvlediani N.D., Inoyatov Zh.Sh. Sexual func-tion of patients undergoing radical prostatectomy: a modern view of the problem. Urologiia. 2015;(2):112-116. (In Russian). eLIBRARY ID: 23608526; EDN: TWQGOH

52. Parekh A., Chen M.H., Hoffman K.E., Choueiri T.K., Hu J.C., Bennett C.L., Kattan M.W., Sartor O., Stein K., Graham P.L., D’Amico A.V., Nguyen P.L. Reduced penile size and treatment regret in men with recurrent prostate cancer after surgery, radiotherapy plus androgen deprivation, or radiotherapy alone. Urology. 2013;81(1):130-134. DOI: 10.1016/j.urology.2012.08.068

53. Msezane L.P., Reynolds W.S., Gofrit O.N., Shalhav A.L., Zagaja G.P., Zorn KC. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008;22(1):97-104. PMID: 18326071.

54. Royuk R.V. Optimizatsiya metodov diagnostiki i korrektsii oslozhneniy radikalnoy prostatektomii [dissertation]. Moscow; 2007. (In Russian). Accessed November 03, 2025. URL: https://www.dissercat.com/content/optimizatsiya-metodovdiagnostiki-i-korrektsii-oslozhnenii-radikalnoi-prostatektomii

55. Sitnikov N.V. Profilaktika oslozhneniy i rannyaya reabilitatsiya bolnykh posle radikalnoy prostatektomii [dissertation]. Moscow; 2008. (In Russian). Accessed November 03, 2025. URL: https://t.dissercat.com/content/profilaktika-oslozhnenii-i-rannyaya-reabilitatsiya-bolnykh-posle-radikalnoi-prostatektomii

56. Kotov S.V. Profilaktika erektil’noj disfunkcii posle nervosberegayushchej radikal’noj prostatektomii [dissertation]. Moscow; 2009. (In Russian). Accessed November 03, 2025. URL: https://www.dissercat.com/content/profilaktika-erektilnoi-dis-funktsii-posle-nervosberegayushchei-radikalnoi-prostatektomii

57. Sari Motlagh R., Abufaraj M., Yang L., Mori K., Pradere B., Laukhtina E., Mostafaei H., Schuettfort V.M., Quhal F., Montorsi F., Amjadi M., Gratzke C., Shariat S.F. Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials. J Urol. 2021;205(4):1018-1030. DOI: 10.1097/JU.0000000000001584

58. Carrier J., Edwards D., Harden J. Men’s perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life: a qualitative systematic review. JBI Database System Rev Implement Rep. 2018;16(4):892-972. DOI: 10.11124/JBISRIR-2017-003566

59. Osoba D., Bezjak A., Brundage M., Pater J.; National Cancer Institute of Canada Clinical Trials Group. Evaluating health-related quality of life in cancer clinical trials: the National Cancer Institute of Canada Clinical Trials Group experience. Value Health. 2007;10 Suppl 2:S138-45. DOI: 10.1111/j.1524-4733.2007.00278.x

60. Kang H.W., Lee J.Y., Kwon J.K., Jeh S.U., Jung H.D., Choi Y.D. Current status of radical prostatectomy for high-risk prostate cancer. Korean J Urol. 2014;55(10):629-635. DOI: 10.4111/kju.2014.55.10.629


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Shamin M.V., Kyzlasov P.S., Kuzmin I.V., Bragin-Maltsev A.I., Volokitin E.V., Gural A.K. Simultaneous penile prothesis implantation during radical prostatectomy in patients with localized prostate cancer and erectile dysfunction. Urology Herald. 2026;14(3):94-104. (In Russ.) https://doi.org/10.21886/2308-6424-2026-14-3-94-104

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