Introduction. Radical prostatectomy (RPE) is considered the «gold standard» treatment for localized prostate cancer with a 15-year cancer-specific survival rate of up to 97%. Despite the technical improvements in surgical techniques, urinary incontinence and erectile dysfunction remain the main functional complications of REM, significantly affecting the quality of life of patients.
Objective. To compare the outcomes of penile prosthesis (PP), artificial urinary sphincter (AUS), and male sling (MS) implantation in patients with erectile dysfunction and urinary incontinence depending on a history of radical prostatectomy (RP).
Materials and methods. A retrospective-prospective cohort study was conducted involving 125 patients who underwent 140 implantations, available for follow-up: 54 PP implantations, 49 AUS implantations, and 37 MS placements from October 2011 to May 2025. Patients were divided into RP and non-RP groups based on the presence of radical prostatectomy in their medical history.
Results. For penile prostheses, the rates of efficacy, satisfaction, and complications in the RP group were 97.2%, 86.1%, and 16.7%, respectively, while in the non-RP group they were 100%, 83.3%, and 5.6%. For AUS, the rates of cure (0-1 pad/day), improvement (reduction in urine loss by more than 50%), and complications in the RP group were 68.8%, 12.5%, and 21.9%, respectively, while in the non-RP group they were 58.8%, 11.8%, and 29.4%. For MS, the rates of cure, improvement, and complications in the RP group were 28.6%, 19%, and 28.6%, respectively, while in the non-RP group they were 18.8%, 12.5%, and 37.5%. All differences between groups were statistically non-significant, p>0.05. Cavernous fibrosis was significantly more common in the non-RP group (33.3% vs. 2.8%, p=0.004) and was associated with a 35-minute increase in surgery duration and a 3.4 cm reduction in implant length (p < 0.05). Obesity was a significant predictor of AUS implantation failure, reducing the cure rate from 81.5% to 45.5% (p=0.014) and increasing the risk of complications by 5.5-fold (95% CI 1.273–24.104). History of surgical treatment for urethral stricture, diabetes mellitus, and baseline urine loss >300 grams per day significantly worsened male sling implantation outcomes.
Conclusion. The conducted study demonstrates comparable efficacy and safety of penile prostheses, artificial urinary sphincter, and male slings implantation in patients regardless of RP history. The obtained data indicate that previous RP is not a factor that negatively affects implantation outcomes.
