Surgical and Functional Outcomes of Penile Prosthesis Implantation in Men with Neurological Conditions

Abstract Objectives Pharmacological treatment for erectile dysfunction (ED) is not always effective in patients with neurological disease; as such, penile prosthesis implant (PPI) can be a valid treatment option. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses (INSIST-ED) Methods INSIST-ED registry, relating to patients implanted from 2014 to 2021, was analyzed. All data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a data-manager. We selected patients with neurological disease undergoing PPI for ED. Follow-up was scheduled at 3,6 and 12 months, then annually. We evaluated postoperative complications and functional outcomes through validated questionnaires (IIEF and EDITS). A non-validated questionnaire was administered to evaluate patient’satisfaction. Results 33 patients were included with a median age of 52 (IQR: 44.75-55.25). Peno-scrotal approach for PPI was performed in most cases (90.9%) while infra-pubic was used in 3 cases (9.1%). An inflatable and a malleabel device was implanted in 30 (90.9 %) and 3 cases (9.1 %), respectively. Median follow-up was 83 months (IQR: 67-99.5). Intraoperative complications occurred in one case (3%). Early postoperative complications (<90 days) were observed in 4 cases (12.1%): 3 peno-scrotal hematoma (Clavien-Dindo G1), 1 device infection requiring prosthesis explant (Clavien-Dindo G3a). At the last follow-up, 29 prostheses (87.9%) were still in place and well-functioning. Mechanical failure of inflatable PP occurred in 3 cases (9.1%). Median IIEF before surgery was 32 (IQR 30.25-36). At the last follow-up, IIEF was 61.5 (IQR 60.25-64.25), and median EDITS was 45.5 (IQR 39-46.75). Overall, 29 patients (87.9%) affirmed to be fully satisfied with the PPI. Conclusions Although PPI in the neurological population has been historically limited by the evidence of common complications and infections, our study showed that PPI represents a safe and effective procedure to treat ED in neurological patients. Conflicts of Interest The Authors have no conflict of interest.