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Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review

International Journal of Impotence Research volume 37, pages 18–26 (2025)Cite this article

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Abstract

Solid organ transplant recipients exhibit an elevated incidence of erectile dysfunction, attributed to comorbidities and specific factors associated with organ failure. While treatment mirrors the general population’s, response rates are lower, and there is a heightened concern about implanting a penile prosthesis in immunocompromised patients due to the potential occurrence of severe complications. The aim of this study was to assess the safety of penile prostheses in this population. Among fourteen included studies, ten were case reports or series of cases, and four were non randomized case-control studies with non-transplanted patients as controls. Complications affected 34 patients (11.15%), with mechanical device failures in 18 cases (5.9%) and infections in 13 cases (4.26%). Most infections required hospitalization, antibiotic treatment, and prosthesis removal, with two cases of life-threatening Fournier’s gangrene. Case-control studies revealed no differences in overall reoperation rates between transplant recipients and controls. However, pelvic organ transplant recipients undergoing three-piece prosthesis implantation showed higher complications rates related to reservoir issues. Despite limited evidence, case-control studies demonstrated a generally low/moderate risk of bias within each specific domain, although overall bias was moderate/severe. As a result, clinicians may mitigate concerns regarding penile prosthesis implantation in solid organ transplant recipients.

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Fig. 1: Flowchart: Literature Search and Systematic Review Process.
Fig. 2: Risk of Bias and Applicability Judgments Overview Using ROBINS-I.

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Author information

Authors and Affiliations

  1. Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Angelo Territo, Eduard Ruiz-Castañe & Alberto Breda

  2. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Mario Belmonte, Alessio Pecoraro & Riccardo Campi

  3. Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy

    Mario Belmonte & Andrea Cocci

  4. King’s College London, London, UK

    Fabio Castiglione

  5. Department of Urology, King’s College London Hospital NHS Foundation Trust, London, UK

    Fabio Castiglione

  6. Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Fabio Castiglione

  7. Vita-Salute San Raffaele University, Milan, Italy

    Fabio Castiglione

  8. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131, Genova, Italy

    Guglielmo Mantica

  9. Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France

    Thomas Prudhomme & Thomas Prudhomme

  10. Department of Oncology, Division of Urology, University of Turin, Turin, Italy

    Alberto Piana

  11. Department of Urology, Kidney Transplantation and Reconstructive Urology. Hospital Universitario Clinico San Carlos, Madrid, Spain

    Beatriz Bañuelos Marco

  12. Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey

    Muhammet Irfan Dönmez

  13. Department of Urology, Campus Bio-Medico University, Rome, Italy

    Francesco Esperto

  14. Urology Section, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  15. Department of Urology, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Alicia López-Abad & Alicia López Abad

Authors
  1. Angelo Territo
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  2. Mario Belmonte
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  3. Andrea Cocci
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  4. Eduard Ruiz-Castañe
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  5. Fabio Castiglione
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  6. Guglielmo Mantica
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  7. Thomas Prudhomme
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  8. Alessio Pecoraro
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  9. Alberto Piana
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  10. Beatriz Bañuelos Marco
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  12. Francesco Esperto
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  13. Giorgio Ivan Russo
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  14. Riccardo Campi
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  16. Alicia López-Abad
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Consortia

On behalf of the Young Academic Urologists (YAU) Kidney Transplantation working group

  • Angelo Territo
  • , Alberto Piana
  • , Thomas Prudhomme
  • , Alessio Pecoraro
  • , Beatriz Bañuelos Marco
  •  & Alicia López Abad

Contributions

Conception and design: AT, Acquisition of data: ALA, MB, Analysis and interpretation of data: AT, ALA, MB, Drafting of the manuscript: AT, ALA, MB. Critical revision of the manuscript for important intellectual content: AC, ERC, FC, GM, TP, APi, APe, BBM, MID, FE, GIR, RC, AB.

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Correspondence to Angelo Territo.

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Territo, A., Belmonte, M., Cocci, A. et al. Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review. Int J Impot Res 37, 18–26 (2025). https://doi.org/10.1038/s41443-024-00939-x

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