Patient-Reported Penile Sensory Loss, Not Surgical Approach, Is Associated with Sexual Satisfaction After Inflatable Penile Prosthesis Implantation

After IPP surgery in 159 men, sensory loss predicted 17.7-point lower satisfaction scores; penoscrotal vs. infrapubic approach made no difference

Journal: The Journal of Sexual Medicine | Published: 2026-04-09 | Type: Retrospective Observational Study | PMID: 41999394 Authors: Akdag A., Aktas E., Canat H.L. — all from Basaksehir Cam Sakura City Hospital, Istanbul, Turkey Funding/COI: Neither disclosed

Summary

A retrospective single-center study of 159 men receiving three-piece inflatable penile prostheses found that postoperative penile sensory loss was the only independent predictor of reduced sexual satisfaction — outweighing age, comorbidities, complications, and device malfunction combined. Penoscrotal and infrapubic surgical approaches produced statistically equivalent sensory and satisfaction outcomes, though the penoscrotal route generated more complications (mostly minor). The implication is straightforward: how a man feels physically after implantation matters more to his sexual satisfaction than which incision his surgeon chose.

Claims

• Penile sensory loss independently predicted lower New Sexual Satisfaction Scale (NSSS) scores (β = −17.72; 95% CI −22.13 to −13.31; P < .001)
• No other variable tested — age, BMI, Charlson Comorbidity Index, ED etiology, smoking history, complications, or device malfunction — independently predicted satisfaction (all P > .05)
• No significant difference between penoscrotal and infrapubic approaches in postoperative sensory loss (P = .234) or NSSS scores (P = .181)
• Penoscrotal approach had a higher overall Clavien-Dindo complication rate (76.5% vs. 43.5%, P < .001), driven primarily by low-grade (Grade I–II) events
• Device malfunction rates were identical between groups (17.6% vs. 17.6%)

Study Quality

The multivariate linear regression controlled for a reasonable range of covariates, and using the NSSS — a validated multidimensional instrument — gives the satisfaction data more weight than a single-item scale would. Excluding patients with pre-existing neurological conditions that affect genital sensation is methodologically sensible and reduces a major confound.

The central weakness is the sensory measure itself: a single binary yes/no question ("Do you currently experience loss of penile sensation?") administered during face-to-face interviews. This is not a validated instrument, is inherently subjective, and carries social desirability bias in an in-person clinical setting. Critically, there is no preoperative sensory baseline — meaning it is impossible to determine whether men reporting postoperative sensory loss had it before surgery. The retrospective design precludes causal inference, and with minimum follow-up of only nine months and no reported median, the durability of these satisfaction outcomes is unknown.

Red Flags

• Single-center, single-country study (Istanbul, Turkey) — limits generalizability to other populations and surgical settings
• Sensory loss captured by one binary question, not a validated psychometric instrument
• No preoperative sensory baseline — cannot confirm that reported loss is new, not pre-existing
• Retrospective design introduces selection bias, recall bias, and unmeasured confounders
• Funding source and conflicts of interest are both undisclosed — unusual for a prosthesis outcomes study where device manufacturer relationships are common
• Follow-up floor is nine months; no median or upper bound reported; long-term stability is unknown
• No partner-reported outcome data; satisfaction is assessed only from the implanted patient

Strengths

• 159 patients is a respectable cohort size for a single-center IPP outcomes study
• NSSS is a validated, multidimensional scale — stronger than single-item satisfaction measures
• Clavien-Dindo grading applied for systematic, standardized complication classification
• Neurological patients excluded to reduce sensory confounding
• Head-to-head comparison of two established surgical approaches with matched follow-up criteria

Verdict

The core finding — that penile sensory loss after prosthesis implantation predicts a nearly 18-point drop in sexual satisfaction, while surgical approach does not — is clinically plausible and practically relevant for preoperative counseling. But this study is not in a position to prove that finding. A single binary sensory question with no preoperative baseline, a retrospective design, undisclosed funding, and a single Turkish center are not the building blocks of definitive evidence. Treat this as a well-framed hypothesis that warrants a prospective study with validated sensory assessment, documented baselines, and longer follow-up before it meaningfully changes how surgeons counsel patients.