Penile prosthesis implantation remains one of the most effective and definitive treatments for erectile dysfunction (ED), particularly when conservative measures fail or are no longer appropriate. While prostheses offer high satisfaction rates across diverse patient populations, the context in which patients require these devices significantly shapes expectations, psychological comfort, and postoperative outcomes. In particular, individuals undergoing radical prostatectomy (RP) or radical cystoprostatectomy (RCP) represent surgical cohorts with unique anatomical challenges, emotional burdens, and quality-of-life considerations.
The article “Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population” presents one of the most detailed investigations into how these populations differ in terms of postoperative satisfaction and functional outcomes, using validated patient-reported instruments such as the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), quality-of-life surveys, and partner-reported metrics.
This comprehensive review synthesizes the findings into an accessible yet medically rigorous narrative, offering deep insight into patient-centered outcomes and guiding counseling strategies for clinicians and surgeons.
Understanding the Surgical Context: Why RP and RCP Patients Differ From the General ED Population
Erectile dysfunction in the general population typically arises from metabolic, vascular, endocrine, or psychogenic causes. In contrast, the pathophysiology of ED after radical prostatectomy or cystoprostatectomy is fundamentally different: it is most often the result of iatrogenic neurovascular injury, pelvic structural modification, and loss of prostatic architecture.
Radical Prostatectomy (RP)
RP disrupts the neurovascular bundles that innervate penile erectile tissue. Even in nerve-sparing procedures, transient neuropraxia and microvascular injury often result in prolonged ED. Patients frequently describe:
• drastic decline in spontaneous erections
• disrupted orgasmic function
• loss of penile length
• climacturia (orgasm-associated incontinence)
These issues alter expectations for sexual rehabilitation and influence how men perceive prosthesis outcomes.
Radical Cystoprostatectomy (RCP)
RCP, performed mostly for invasive bladder cancer, involves more extensive anatomical removal, greater disruption of pelvic neurovascular structures, and—in many cases—urinary diversion. It often results in:
• complete loss of natural erectile function
• significant changes in body image
• chronic adaptation to urinary diversion appliances
• complex psychological recovery linked to cancer survivorship
Thus, RCP patients approach penile prosthesis surgery with expectations shaped by cancer treatment, survival psychology, and major lifestyle transitions.
General Population ED
Men seeking prostheses outside these surgical cohorts typically struggle with:
• vasculogenic ED
• diabetes-related neuropathy
• medication-related sexual dysfunction
• Peyronie’s disease
They often retain normal orgasmic function, penile sensation, and hormonal balance. Their expectations may center on returning to previous sexual performance rather than achieving sexual function after oncologic surgery.
The different starting points explain why satisfaction rates vary across groups—yet surprisingly, the study reveals that even men with more severe baseline challenges report high satisfaction post-implantation.
Study Design: How Satisfaction Was Measured and Compared
The research used a multicenter cohort design evaluating satisfaction outcomes among:
• Post-RP patients
• Post-RCP patients
• General ED population receiving prostheses
Satisfaction metrics included:
- EDITS scores (primary satisfaction instrument)
- Global assessments of postoperative sexual function
- Partner satisfaction data
- Device-related metrics: ease of use, pain, reliability
- Overall quality-of-life impact
The dataset included multiple prosthesis types, predominantly inflatable penile prostheses (IPPs), reflecting modern clinical practice. Notably, the investigators also considered comorbidities and demographic variations—critical factors influencing satisfaction.
Visuals in the PDF, particularly charts showing distribution of EDITS scores (pages 4–5), highlight how postoperative satisfaction clusters consistently at the higher end of the scale across all groups.
Key Findings: Penile Prostheses Deliver High Satisfaction Across All Groups—but With Nuanced Differences
1. Overall Satisfaction Levels Were High in All Cohorts
The majority of men across all groups reported satisfaction rates exceeding 80%, demonstrating that penile prosthesis implantation remains one of the most reliable and successful interventions for ED. This finding is consistent with decades of prosthesis research.
However, the data reveal subtle but meaningful distinctions:
- General population patients showed the highest satisfaction, likely due to fewer baseline pelvic changes and higher likelihood of achieving sex resembling pre-ED function.
- RP patients demonstrated slightly lower satisfaction, often linked to residual sexual dysfunction unrelated to erection rigidity (e.g., orgasmic issues).
- RCP patients reported the most complex post-implant experiences, but still exhibited strong satisfaction overall, reflecting the profound psychological dimension of “sexual restoration” after cancer surgery.
These findings are displayed clearly in the study’s bar charts comparing mean EDITS values.
2. RCP Patients Showed the Lowest Orgasmic Satisfaction—But High Prosthesis Satisfaction
One of the most striking findings is the divergence between:
- orgasmic function
and - overall device satisfaction
RCP patients frequently reported:
- diminished orgasm intensity
- altered orgasm quality
- reduced penile sensation
- concerns about body image related to urinary diversion
Yet despite these challenges, their satisfaction with the prosthesis remained high, driven by improved psychological well-being, restored sexual capability, and renewed intimacy with partners.
This highlights a fundamental truth in sexual medicine:
satisfaction is not purely functional—it is emotional, relational, and identity-based.
3. Partners’ Satisfaction Closely Mirrored Patients’ Satisfaction
Partner-reported outcomes demonstrated high levels of satisfaction, especially when:
- communication between partners was strong
- sexual function had been absent for long periods pre-implant
- partners perceived prosthesis use as restoring relational normalcy
Interestingly, the study notes that partners of RCP patients often displayed equal or greater satisfaction compared to partners of RP patients.
This reflects the emotional dynamics of survivorship: partners often prioritize restored intimacy over penile sensation or ejaculation metrics.
4. Mechanical Reliability and Ease of Use Strongly Influenced Satisfaction
Across all groups, the factors most predictive of satisfaction were:
- trouble-free device function
- ease of inflation and deflation
- minimal postoperative pain
- absence of mechanical malfunction
This reinforces the importance of:
- proper device selection
- preoperative counseling
- postoperative training in pump use
- realistic expectation management
In charts on pages 6–7, device function and ease-of-use scores cluster tightly in the “high” ranges, correlating strongly with higher EDITS scores.
Why Prostatectomy and Cystoprostatectomy Patients Still Report High Satisfaction
1. Because prostheses restore what surgery took away
Men undergoing RP or RCP often experience sudden, complete loss of erectile function—something psychologically devastating. A prosthesis restores a functional erection regardless of nerve status, offering:
- renewed masculinity
- restored sexual agency
- improved emotional well-being
This contrast between pre- and post-implant function produces disproportionately positive satisfaction despite persistent issues in orgasm or sensation.
2. Because expectations are different
The study notes that general ED patients often have higher expectations of “returning to normal sex.”
Meanwhile, RP and RCP patients:
- perceive prostheses as “rescue therapy”
- have realistic expectations set by surgical counseling
- compare outcomes to the absence of sexual function rather than past performance
Hence, even moderate improvements feel transformative.
3. Because partners often share in the recovery narrative
Cancer couples frequently:
- redefine intimacy
- value return of sexual closeness
- experience prosthesis implantation as a milestone in recovery
Thus, satisfaction is shaped by relational context rather than performance metrics alone.
Challenges Reported by Patients: What Still Needs Improvement
The study identifies several areas where satisfaction declines:
Orgasmic Dysfunction (Especially Post-RP and Post-RCP)
Loss of ejaculate, diminished intensity, and climacturia negatively affect satisfaction independent of erections.
Penile Length Perception
Many patients—especially postoperative cancer cohorts—report perceived penile shortening. Even if objective length loss is minimal, psychological perception strongly influences satisfaction.
Body Image Disturbances in RCP Patients
Urinary diversion appliances, abdominal scarring, and altered anatomy impact confidence and sexual spontaneity.
Fear of Mechanical Failure
Even when devices perform perfectly, anxiety about mechanical longevity reduces sexual spontaneity for some patients.
Broader Clinical Implications: What This Study Means for Patient Counseling
1. Counseling Must Be Tailored to Patient Background
RP and RCP patients require specific conversations about orgasmic changes, sensation alterations, and pelvic anatomy implications—not just erection mechanics.
2. Partner Involvement Improves Outcomes
The study strongly supports including partners in preoperative and postoperative education, as satisfaction is dyadic, not individual.
3. Device Choice Should Reflect Functional Priorities
For example:
- Post-cancer patients may benefit from inflatable prostheses due to more natural appearance.
- Patients with manual dexterity issues may prefer malleable devices.
4. Managing Expectations Is Crucial
The study repeatedly emphasizes that dissatisfaction almost always emerges when expectations exceed realistic outcomes.
Conclusion
This study provides a nuanced and clinically valuable analysis of satisfaction following penile prosthesis implantation across three distinct populations: post-radical prostatectomy, post-radical cystoprostatectomy, and the general ED population. Despite anatomical, psychological, and functional differences, satisfaction rates remain remarkably high across all cohorts.
RP and RCP patients report slightly lower sexual function scores but still exhibit strong overall satisfaction due to the profound impact prostheses have on restoring sexual capability, identity, and relationship intimacy.
The results highlight the essential roles of:
- patient–partner communication
- proper device education
- individualized counseling
- realistic expectation management
Ultimately, penile prosthesis implantation stands as a reliable, life-enhancing therapy for men with severe ED, regardless of underlying etiology.
FAQ
1. Are penile prostheses equally effective for men after radical prostatectomy and cystoprostatectomy?
Yes. Although orgasmic function may differ, satisfaction with erections and the device itself remains high in both groups.
2. Do partners report high satisfaction after prosthesis implantation?
Generally, yes. Partner satisfaction closely mirrors patient satisfaction and is especially strong in cancer-survivorship couples.
3. What most strongly predicts satisfaction after implantation?
Reliable device function, ease of use, realistic preoperative expectations, and emotional readiness for sexual rehabilitation.
