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Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities


Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer. One of the most feared post-surgical complications is erectile dysfunction (ED), usually caused by direct damage to the cavernous nerves or due to neuropraxia. Penile rehabilitation is an emerging concept that was proposed to stimulate and accelerate recovery of erectile function after RP. The goal is to improve blood flow to the penis, increasing cavernous oxygenation and avoiding fibrosis. The most common used modalities include oral phosphodiesterase type 5 inhibitors (PDE5-I), vacuum erection devices (VEDs), intracorporeal injection (ICI) therapy, medicated urethral system for erections (MUSE), and a combination of these treatments. For those patients with severe ED, ED refractory to medical therapy and/or seeking long term reliable results, the penile prosthesis implant remains an excellent alternative. We conducted a broad review of post-prostatectomy ED prevalence with different techniques and the success rates of the different therapeutic approaches.

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  1. 1.

    American Cancer Society. Facts & Figures 2020. Atlanta, GA: American Cancer Society; 2020.

  2. 2.

    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29.

    Google Scholar 

  3. 3.

    Borregales LD, Berg WT, Tal O, Wambi C, Kaufman S, Gaya JM, et al. ‘Trifecta’ after radical prostatectomy: is there a standard definition? BJU Int. 2013;112:60–7.

    PubMed  Google Scholar 

  4. 4.

    Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol. 2010;57:179–92.

    PubMed  Google Scholar 

  5. 5.

    Masterson TA, Serio AM, Mulhall JP, Vickers AJ, Eastham JA. Modified technique for neurovascular bundle preservation during radical prostatectomy: association between technique and recovery of erectile function. BJU Int. 2008;101:1217–22.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Glickman L, Godoy G, Lepor H. Changes in continence and erectile function between 2 and 4 years after radical prostatectomy. J Urol. 2009;181:731–5.

    PubMed  Google Scholar 

  7. 7.

    Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62:418–30.

    PubMed  Google Scholar 

  8. 8.

    Kim SC, Song C, Kim W, Kang T, Park J, Jeong IG, et al. Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic. Eur Urol. 2011;60:413–9.

    PubMed  Google Scholar 

  9. 9.

    Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, et al. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int. 2009;103:448–53.

    PubMed  Google Scholar 

  10. 10.

    Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999;162:433–8.

    CAS  PubMed  Google Scholar 

  11. 11.

    Fulmer BR, Bissonette EA, Petroni GR, Theodorescu D. Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma: comparison of radical prostatectomy to hormonobrachytherapy with and without external beam radiotherapy. Cancer. 2001;91:2046–55.

    CAS  PubMed  Google Scholar 

  12. 12.

    Guillonneau B, Cathelineau X, Doublet JD, Baumert H, Vallancien G. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol. 2002;43:123–33.

    PubMed  Google Scholar 

  13. 13.

    Katz R, Salomon L, Hoznek A, de la Taille A, Vordos D, Cicco A, et al. Patient reported sexual function following laparoscopic radical prostatectomy. J Urol. 2002;168:2078–82.

    PubMed  Google Scholar 

  14. 14.

    Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172:2227–31.

    PubMed  Google Scholar 

  15. 15.

    Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, et al. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst. 2004;96:1358–67.

    PubMed  Google Scholar 

  16. 16.

    Dubbelman YD, Dohle GR, Schröder FH. Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. Eur Urol. 2006;50:711–8.

    PubMed  Google Scholar 

  17. 17.

    Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology. 2003;62:292–7.

    PubMed  Google Scholar 

  18. 18.

    Roumeguere T, Bollens R, Vanden Bossche M, Rochet D, Bialek D, Hoffman P, et al. Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol. 2003;20:360–6.

    PubMed  Google Scholar 

  19. 19.

    Joseph JV, Vicente I, Madeb R, Erturk E, Patel HR. Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences? BJU Int. 2005;96:39–42.

    PubMed  Google Scholar 

  20. 20.

    Meuleman EJH, Mulders PFA. Erectile function after radical prostatectomy: a review. Eur Urol. 2003;43:95–102.

    CAS  PubMed  Google Scholar 

  21. 21.

    Geary ES, Dendinger TE, Freiha FS, Stamey TA. Nerve sparing radical prostatectomy: a different view. J Urol. 1995;154:145–9.

    CAS  PubMed  Google Scholar 

  22. 22.

    Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, et al. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer. 2002;95:1773–85.

    PubMed  Google Scholar 

  23. 23.

    Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283:354–60.

    CAS  PubMed  Google Scholar 

  24. 24.

    Carlucci JR, Nabizada-Pace F, Samadi DB. Robot-assisted laparoscopic radical prostatectomy: technique and outcomes of 700 cases. Int J Biomed Sci. 2009;5:201–8.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Rodriguez E Jr., Finley DS, Skarecky D, Ahlering TE. Single institution 2-year patient reported validated sexual function outcomes after nerve sparing robot assisted radical prostatectomy. J Urol. 2009;181:259–63.

    PubMed  Google Scholar 

  26. 26.

    Shikanov SA, Zorn KC, Zagaja GP, Shalhav AL. Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology. 2009;74:619–23.

    PubMed  Google Scholar 

  27. 27.

    Ploussard G, Xylinas E, Salomon L, Vordos D, Hoznek A, Abbou CC, et al. Robot-assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high-volume laparoscopy reference centre. BJU Int. 2010;105:1155–60.

    PubMed  Google Scholar 

  28. 28.

    Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, et al. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med. 2010;7:445–75.

    CAS  PubMed  Google Scholar 

  29. 29.

    Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128:492–7.

    CAS  PubMed  Google Scholar 

  30. 30.

    Castiglione F, Ralph DJ, Muneer A. Surgical techniques for managing post-prostatectomy erectile dysfunction. Curr Urol Rep. 2017;18:90.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Mulhall JP, Slovick R, Hotaling J, Aviv N, Valenzuela R, Waters WB, et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol. 2002;167:1371–5.

    PubMed  Google Scholar 

  32. 32.

    Leungwattanakij S, Bivalacqua TJ, Usta MF, Yang DY, Hyun JS, Champion HC, et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl. 2003;24:239–45.

    PubMed  Google Scholar 

  33. 33.

    Moreland RB. Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res. 1998;10:113–20.

    CAS  PubMed  Google Scholar 

  34. 34.

    Kim N, Vardi Y, Padma-Nathan H, Daley J, Goldstein I, Saenz, et al. Oxygen tension regulates the nitric oxide pathway. Physiological role in penile erection. J Clin Invest. 1993;91:437–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol. 1987;137:829–36.

    CAS  PubMed  Google Scholar 

  36. 36.

    van Poppel H, Everaerts W, Tosco L, Joniau S. Open and robotic radical prostatectomy. Asian J Urol. 2019;6:125–8.

    PubMed  Google Scholar 

  37. 37.

    Nelson CJ, Scardino PT, Eastham JA, Mulhall JP. Back to baseline: erectile function recovery after radical prostatectomy from the patients’ perspective. J Sex Med. 2013;10:1636–43.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Salonia A, Adaikan G, Buvat J, Carrier S, El-Meliegy A, Hatzimouratidis K, et al. Sexual rehabilitation after treatment for prostate cancer-part 1: recommendations from the fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017;14:285–96.

    PubMed  Google Scholar 

  39. 39.

    Liu C, Lopez DS, Chen M, Wang R. Penile rehabilitation therapy following radical prostatectomy: a meta-analysis. J Sex Med. 2017;14:1496–503.

    PubMed  Google Scholar 

  40. 40.

    Gandaglia G, Suardi N, Cucchiara V, Bianchi M, Shariat SF, Roupret M, et al. Penile rehabilitation after radical prostatectomy: does it work? Transl Androl Urol. 2015;4:110–23.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N. Engl J Med. 2008;358:1250–61.

    CAS  PubMed  Google Scholar 

  42. 42.

    Punnen S, Cowan JE, Chan JM, Carroll PR, Cooperberg MR. Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry. Eur Urol. 2015;68:600–8.

    Google Scholar 

  43. 43.

    Chambers SK, Occhipinti S, Stiller A, Zajdlewicz L, Nielsen L, Wittman D, et al. Five-year outcomes from a randomised controlled trial of a couples-based intervention for men with localised prostate cancer. Psychooncology. 2019;28:775–83.

    PubMed  Google Scholar 

  44. 44.

    Canada AL, Neese LE, Sui D, Schover LR. Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma. Cancer. 2005;104:2689–700.

    PubMed  Google Scholar 

  45. 45.

    Mulhall JP, Parker M, Waters BW, Flanigan R. The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function. BJU Int. 2010;105:37–41.

    PubMed  Google Scholar 

  46. 46.

    Jo JK, Jeong SJ, Oh JJ, Lee SW, Lee S, Hong SK, et al. Effect of starting penile rehabilitation with sildenafil immediately after robot-assisted laparoscopic radical prostatectomy on erectile function recovery: a prospective randomized trial. J Urol. 2018;199:1600–6.

    CAS  PubMed  Google Scholar 

  47. 47.

    Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile dysfunction. P T. 2013;38:407–19.

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Fode M, Ohl DA, Ralph D, Sønksen J. Penile rehabilitation after radical prostatectomy: what the evidence really says. BJU Int. 2013;112:998–1008.

    PubMed  Google Scholar 

  49. 49.

    Kovanecz I, Rambhatla A, Ferrini M, Vernet D, Sanchez S, Rajfer J, et al. Long-term continuous sildenafil treatment ameliorates corporal veno-occlusive dysfunction (CVOD) induced by cavernosal nerve resection in rats. Int J Impot Res. 2008;20:202–12.

    CAS  PubMed  Google Scholar 

  50. 50.

    Mulhall J, Land S, Parker M, Waters WB, Flanigan RC. The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med. 2005;2:532–40.

    CAS  PubMed  Google Scholar 

  51. 51.

    Mulhall JP, Brock G, Oelke M, Fode M, Probst KA, Henneges C, et al. Effects of tadalafil once-daily or on-demand vs placebo on return to baseline erectile function after bilateral nerve-sparing radical prostatectomy-results from a randomized controlled trial (REACTT). J Sex Med. 2016;13:679–83.

    PubMed  Google Scholar 

  52. 52.

    Raina R, Agarwal A, Ausmundson S, Lakin M, Nandipati KC, Montague DK, et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res. 2006;18:77–81.

    CAS  PubMed  Google Scholar 

  53. 53.

    Basal S, Wambi C, Acikel C, Gupta M, Badani K. Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function. BJU Int. 2013;111:658–65.

    CAS  PubMed  Google Scholar 

  54. 54.

    Lehrfeld T, Lee DI. The role of vacuum erection devices in penile rehabilitation after radical prostatectomy. Int J Impot Res. 2009;21:158–64.

    CAS  PubMed  Google Scholar 

  55. 55.

    Yuan J, Hoang AN, Romero CA, Lin H, Dai Y, Wang R. Vacuum therapy in erectile dysfunction—science and clinical evidence. Int J Impot Res. 2010;22:211–9.

    CAS  PubMed  Google Scholar 

  56. 56.

    Kim N, Azadzoi KM, Goldstein I, Saenz, de Tejada I. A nitric oxide-like factor mediates nonadrenergic-noncholinergic neurogenic relaxation of penile corpus cavernosum smooth muscle. J Clin Invest. 1991;88:112–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N. Engl J Med. 1992;326:90–4.

    CAS  PubMed  Google Scholar 

  58. 58.

    National Center for Biotechnology Information. PubChem Compound Summary for CID 5775, Phentolamine. Accessed Nov. 13, 2020.

  59. 59.

    Melanie R, Hew VG. Prostaglandin E1. Treasure Island, FL: StatPearls Publishing; 2020.

    Google Scholar 

  60. 60.

    National Center for Biotechnology Information. PubChem Compound Summary for CID 4680, Papaverine. Accessed Nov. 13, 2020.

  61. 61.

    Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N. Engl J Med. 1996;334:873–7.

    CAS  PubMed  Google Scholar 

  62. 62.

    Virag R, Shoukry K, Floresco J, Nollet F, Greco E. Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases. J Urol. 1991;145:287–92.

    CAS  PubMed  Google Scholar 

  63. 63.

    Montorsi F, Guazzoni G, Strambi LF, Da Pozzo LF, Nava L, Barbieri L, et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol. 1997;158:1408–10.

    CAS  PubMed  Google Scholar 

  64. 64.

    Zorgniotti AW, Lefleur RS. Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol. 1985;133:39–41.

    CAS  PubMed  Google Scholar 

  65. 65.

    Deveci S, Mulhall JP. Chapter 37 - Male sexual dysfunction. In: Legato MJ, editor. Principles of gender-specific medicine. Second Edition San Diego: Academic Press; 2010. p 408–13.

    Google Scholar 

  66. 66.

    Eardley I, Donatucci C, Corbin J, El-Meliegy A, Hatzimouratidis K, McVary K, et al. Pharmacotherapy for erectile dysfunction. J Sex Med. 2010;7:524–40.

    CAS  PubMed  Google Scholar 

  67. 67.

    Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med. 2013;10:130–71.

    CAS  PubMed  Google Scholar 

  68. 68.

    Lakin MM, Montague DK, VanderBrug Medendorp S, Tesar L, Schover LR. Intracavernous injection therapy: analysis of results and complications. J Urol. 1990;143:1138–41.

    CAS  PubMed  Google Scholar 

  69. 69.

    Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama à Nijeholt GA, et al. Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group. Br J Urol. 1998;81:889–94.

    PubMed  Google Scholar 

  70. 70.

    McCullough AR, Hellstrom WG, Wang R, Lepor H, Wagner KR, Engel JD. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. J Urol. 2010;183:2451–6.

    CAS  PubMed  Google Scholar 

  71. 71.

    Raina R, Pahlajani G, Agarwal A, Zippe CD. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity. BJU Int. 2007;100:1317–21.

    PubMed  Google Scholar 

  72. 72.

    Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Urology. 2000;55:109–13.

    CAS  PubMed  Google Scholar 

  73. 73.

    Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med. 2007;4:1074–9.

    PubMed  Google Scholar 

  74. 74.

    Bettocchi C, Palumbo F, Spilotros M, Lucarelli G, Palazzo S, Battaglia M, et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J Sex Med. 2010;7:304–9.

    PubMed  Google Scholar 

  75. 75.

    Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group. J Urol. 2000;164:376–80.

    CAS  PubMed  Google Scholar 

  76. 76.

    Baas W, O’Connor B, Welliver C, Stahl PJ, Stember DS, Wilson SK, et al. Worldwide trends in penile implantation surgery: data from over 63,000 implants. Transl Androl Urol. 2020;9:31–7.

    PubMed  PubMed Central  Google Scholar 

  77. 77.

    Bajic P, Patel PM, Nelson MH, Dornbier RA, Kirshenbaum EJ, Baker MS, et al. Penile prosthesis implantation and timing disparities after radical prostatectomy: results from a statewide claims database. J Sex Med. 2020;17:1175–81.

    PubMed  Google Scholar 

  78. 78.

    Stephenson RA, Mori M, Hsieh YC, Beer TM, Stanford JL, Gilliland FD, et al. Treatment of erectile dysfunction following therapy for clinically localized prostate cancer: patient reported use and outcomes from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study. J Urol. 2005;174:646–50.

    PubMed  Google Scholar 

  79. 79.

    Tal R, Jacks LM, Elkin E, Mulhall JP. Penile implant utilization following treatment for prostate cancer: analysis of the SEER-Medicare database. J Sex Med. 2011;8:1797–804.

    PubMed  Google Scholar 

  80. 80.

    Salonia A, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioglu A, et al. Management of erectile dysfunction: Eauropean Association of Urology; 2016.

  81. 81.

    Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med. 2013;10:2115–20.

    PubMed  Google Scholar 

  82. 82.

    Henry G, Hsiao W, Karpman E, Bella AJ, Carrion R, Jones L, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11:273–8.

    PubMed  Google Scholar 

  83. 83.

    Stember DS, Garber BB, Perito PE. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. J Sex Med. 2014;11:605–12.

    PubMed  Google Scholar 

  84. 84.

    Thirumavalavan N, Gross MS, Munarriz R. Techniques of ectopic reservoir placement and their pitfalls. J Sex Med. 2017;14:1451–4.

    PubMed  Google Scholar 

  85. 85.

    Perito PE, Wilson SK. Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement. J Sex Med. 2011;8:656–9.

    PubMed  Google Scholar 

  86. 86.

    Steege JF, Stout AL, Carson CC. Patient satisfaction in Scott and Small-Carrion penile implant recipients: a study of 52 patients. Arch Sex Behav. 1986;15:393–9.

    CAS  PubMed  Google Scholar 

  87. 87.

    Tefilli MV, Dubocq F, Rajpurkar A, Gheiler EL, Tiguert R, Barton C, et al. Assessment of psychosexual adjustment after insertion of inflatable penile prosthesis. Urology. 1998;52:1106–12.

    CAS  PubMed  Google Scholar 

  88. 88.

    Akin-Olugbade O, Parker M, Guhring P, Mulhall J. Determinants of patient satisfaction following penile prosthesis surgery. J Sex Med. 2006;3:743–8.

    PubMed  Google Scholar 

  89. 89.

    Serefoglu EC, Mandava SH, Gokce A, Chouhan JD, Wilson SK, Hellstrom WJ. Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med. 2012;9:2182–6.

    CAS  PubMed  Google Scholar 

  90. 90.

    Hellstrom WJ, Montague DK, Moncada I, Carson C, Minhas S, Faria G, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med. 2010;7:501–23.

    PubMed  Google Scholar 

  91. 91.

    Wilson SK, Cleves MA, Delk JR 2nd. Comparison of mechanical reliability of original and enhanced Mentor Alpha I penile prosthesis. J Urol. 1999;162:715–8.

    CAS  PubMed  Google Scholar 

  92. 92.

    Carson CC 3rd, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185:614–8.

    PubMed  Google Scholar 

  93. 93.

    Darouiche RO, Bella AJ, Boone TB, Brock G, Broderick GA, Burnett AL, et al. North American consensus document on infection of penile prostheses. Urology. 2013;82:937–42.

    PubMed  Google Scholar 

  94. 94.

    Zargaroff S, Sharma V, Berhanu D, Pearl JA, Meeks JJ, Dupree JM, et al. National trends in the treatment of penile prosthesis infections by explantation alone vs. immediate salvage and reimplantation. J Sex Med. 2014;11:1078–85.

    PubMed  Google Scholar 

  95. 95.

    Knoll P, Rai S, Talluri S, Bezinque A, Micciche R, Rao G, et al. A survey of usage of penile prosthesis. J Sex Med. 2020;17:2287–90.

    PubMed  Google Scholar 

  96. 96.

    Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post prostatectomy erectile dysfunction. Transl Androl Urol. 2015;4:421–37.

    PubMed  PubMed Central  Google Scholar 

  97. 97.

    Segal RL, Bivalacqua TJ, Burnett AL. Current penile-rehabilitation strategies: clinical evidence. Arab J Urol. 2013;11:230–6.

    PubMed  PubMed Central  Google Scholar 

  98. 98.

    Nandipati K, Raina R, Agarwal A, Zippe CD. Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections. Int J Impot Res. 2006;18:446–51.

    CAS  PubMed  Google Scholar 

  99. 99.

    Köhler TS, Pedro R, Hendlin K, Utz W, Ugarte R, Reddy P, et al. A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU Int. 2007;100:858–62.

    PubMed  Google Scholar 

  100. 100.

    Porst H. Transurethral alprostadil with MUSE (medicated urethral system for erection) vs intracavernous alprostadil-a comparative study in 103 patients with erectile dysfunction. Int J Impot Res. 1997;9:187–92.

    CAS  PubMed  Google Scholar 

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Lima, T.F.N., Bitran, J., Frech, F.S. et al. Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities. Int J Impot Res 33, 401–409 (2021).

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