Surgical Treatment Options for Concomitant Post-Prostatectomy ED and Stress Urinary Incontinence

Simultaneous penile prosthesis + incontinence device implantation appears safe, with continence rates of 72–100% and IPP satisfaction of 84–100% — but all 21 included studies are small and mostly retrospective

Journal: International Journal of Impotence Research | Published: 2025-11-07 | Type: Systematic Review | PMID: 41203816 Authors: Ammirati E., Polisini G., Giammò A. (Città della Salute e della Scienza Hospital, Turin; University of Perugia, Terni, Italy) Funding/COI: Funding not disclosed; no competing interests declared

Summary

Radical prostatectomy frequently leaves men managing both erectile dysfunction and stress urinary incontinence simultaneously — a combination that typically requires two separate corrective surgeries. This systematic review asks whether implanting a penile prosthesis and an anti-incontinence device in a single operation is safe and effective. Based on 21 mostly retrospective studies with very small cohorts, the answer appears to be "probably yes," with the caveat that the evidence base is too weak to be definitive.

Claims

• 21 studies included; cohort sizes ranged from 2 to 65 patients
• Primary etiology across all studies: radical prostatectomy
• Average operating time: 57–218 minutes
• Average hospital stay: 1–3 days
• Follow-up ranged from 1 to 94 months
• Social continence (≤1 pad/day): 72–100% across studies
• Patient satisfaction with inflatable penile prosthesis: 84–100%
• Postoperative complication rate did not appear elevated vs. single-device implantation
• No surgical or technical obstacles specific to synchronous implantation were reported across any study

Study Quality

This is a systematic review of a sparse, low-quality literature. All 21 included studies are primarily retrospective, and the largest cohort contains only 65 patients — underpowered for most surgical outcome analyses. The wide follow-up range (1 to 94 months) means complication and revision rates across studies are essentially incomparable. The authors explicitly acknowledge that heterogeneous outcome measures precluded any pooled analysis, so this is a narrative summary of disparate small studies rather than a meta-analysis. No registered review protocol (PROSPERO or equivalent) is mentioned.

The absence of declared conflicts of interest avoids obvious industry bias, and the ethical committee exemption is standard for literature reviews.

Red Flags

• Maximum cohort size is 65 patients — no individual study is large enough to detect rare complications
• Heterogeneous outcome measures prevent any pooled statistical analysis; the review cannot produce effect sizes or confidence intervals
• All studies predominantly retrospective — no RCTs exist in this space
• Follow-up variability (1–94 months) makes cross-study complication comparisons unreliable
• Data integrity concern: the full-text conclusions provided with this paper appear to belong to a different publication — they reference 12,000 prostatectomy cases, surgical margin status, and NVB-sparing technique, none of which relate to implant data in the abstract. This suggests a metadata error at the source, not in the review itself
• Funding source not disclosed

Strengths

• Addresses a clinically relevant question: simultaneous vs. staged implantation for a common dual complication
• Broad search strategy covering multiple device types: AUS, male sling, ATOMS, ProACT, Mini-Juppette, Virtue, Advance
• Explicit acknowledgment that pooled analysis was not possible — no false precision claimed
• Consistently reported finding across heterogeneous studies: no elevated complication risk with simultaneous implantation

Verdict

This review is as good as the underlying literature allows, which is not saying much. Twenty-one retrospective studies, maximum 65 patients each, with incompatible outcome measures — this is the evidentiary equivalent of a collection of case reports with extra steps. The finding that simultaneous implantation appears safe and adds no surgical complexity is clinically useful as a hypothesis, not as established fact. Until a prospective, adequately powered multicenter trial exists, surgeons making this decision are operating on collective anecdote. Read it for a map of what has been published; do not cite it as evidence that the approach works.