Penile implant after radical prostatectomy

Timing

Erectile function can continue to recover for up to about two years after nerve-sparing radical prostatectomy, so implants are not usually considered immediately. Where the nerves were not spared, or where recovery has plateaued and non-surgical treatment is insufficient, there is no benefit in waiting further. The right timing is a conversation about your surgery, your recovery so far and what you have already tried.

Surgical considerations specific to this group

• The space behind the pubic bone traditionally used for the reservoir has been operated on. Placement in the abdominal wall, or a low-profile reservoir, may be preferred.
• Scarring from the prostatectomy affects dissection and planning.
• Corporal fibrosis can develop over time after prostatectomy, which affects cylinder sizing — another argument against waiting indefinitely.
• If you also have stress urinary incontinence, whether a sphincter and an implant are placed together or sequentially is a planning decision to make explicitly.

What the implant will and will not do

• It will restore reliable rigidity for intercourse.
• It will not restore ejaculation — the prostate and seminal vesicles have been removed. Orgasm is generally still possible, and is dry.
• It will not restore spontaneous erections.
• It will not lengthen the penis, and shortening that has developed since your prostatectomy will not be reversed.
• It will not affect your cancer follow-up or PSA monitoring.

Preparing for the consultation

Bring your prostatectomy operation note, your pathology report, your current PSA and follow-up arrangements, details of any radiotherapy, a list of the erectile dysfunction treatments you have tried, and an account of any urinary symptoms. That set of information is what allows a surgeon to give you a real opinion rather than a general one.