Penile prosthesis in the management of erectile dysfunction following cancer therapy

Erectile dysfunction (ED) continues to be a common problem following the treatment of prostate cancer and other pelvic malignancies. Despite improvements in surgical technique and radiation targeting, a significant percentage of patients suffer worsening erectile function after treatment. Fortunately, many therapeutic modalities exist. The initial management for ED involves oral medications due to availability, ease of use, and acceptable efficacy. A substantial number of patients, however, may be dissatisfied with the effectiveness of oral medications and frequently will progress through intraurethral suppositories, vacuum erection devices and intracavernosal injections. In many instances, patients fail to satisfactorily respond to these treatment options, given the potentially severe vascular, neurologic, histologic and anatomic alterations resulting from cancer therapy. Surgical implantation of an inflatable penile prosthesis (IPP) offers an effective and reliable solution to definitively treat ED in these cases. Longitudinal data supports the efficacy of IPP implantation, and continued research in the field continues to advance the quality of the devices themselves as well as surgical techniques for implantation. Current information indicates, though, that this therapy is underutilized. A study by Tal et al. demonstrated that only 0.78% of men receive an IPP following radical prostatectomy or external beam radiation therapy for prostate cancer (1). This review will discuss the current practice patterns, outcomes and nuances to surgical technique regarding the use of IPPs in patients with ED following cancer therapy