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Surgical treatment options and outcomes for concomitant treatment of post-prostatectomy erectile dysfunction and male stress urinary incontinence: a systematic review of the literature

International Journal of Impotence Research (2025)Cite this article

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Abstract

Simultaneous stress urinary incontinence (SUI) and erectile dysfunction (ED) are commonly caused by prostate surgery. Penile prosthesis is the gold standard for erectile dysfunction refractory to conservative therapies, fixed male sling and artificial urinary sphincter are recommended in mild and moderate/severe stress urinary incontinence respectively. The implantation of these devices can be simultaneous or delayed. This systematic review analyzes articles on simultaneous implantation of penile prosthesis and anti-incontinence devices. We search on Pubmed/Medline and Scopus: “penile prosthesis” AND “artificial urinary sphincter”, “male sling”, “Mini-Juppette”, “ATOMS”, “ProACT”, “urethral bulking”, “Advance”, “Virtue”. We have included 21 studies, mostly retrospective. The size of study cohorts is relatively small (2–65 patients) and the main cause of stress urinary incontinence and erectile dysfunction was radical prostatectomy. The average operating time appeared longer (57–218 min), although without evidence of intraoperative complications and an average hospital stay of 1-3 days. The average follow up of the studies ranged from 1 month to 94 months. Studies expressed different outcomes measurements, that could not allow a cumulative analysis. The overall continence outcomes were encouraging, with social continence rates (no more than 1 pad/day) ranging from 72 to 100%. The overall satisfaction for the inflatable penile prosthesis was high (84–100%). The postoperative complication rate did not show an augmented risk for double implants. All studies did not report any technical or surgical implant obstacles in synchronous versus metachronous implantation.

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Author information

Authors and Affiliations

  1. Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e dellaScienza Hospital, University of Turin, Turin, Italy

    Enrico Ammirati & Alessandro Giammò

  2. Andrology and Urogynecology Clinic, Santa Maria Hospital, University of Perugia, Terni, Italy

    Giordano Polisini

Authors
  1. Enrico Ammirati
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  2. Giordano Polisini
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  3. Alessandro Giammò
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Contributions

Data collection: GP, EA. Data Management and Analysis: GP, EA. Drafting and editing the manuscript: GP, EA, AG. Final revision and approval: AG. All authors have read and approved the final version of this manuscript.

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Correspondence to Enrico Ammirati.

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We did not request the ethical committee approval since our study is a literature review and not an experimental study.

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Ammirati, E., Polisini, G. & Giammò, A. Surgical treatment options and outcomes for concomitant treatment of post-prostatectomy erectile dysfunction and male stress urinary incontinence: a systematic review of the literature. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01202-7

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