Glickman Urological & Kidney Institute Outcomes

Following radical cystectomy (RC) for bladder cancer, permanent erectile dysfunction (ED) can occur in up to 80% of patients. When oral medications fail, placement of an inflatable penile prosthesis (IPP) is a valid second tier option for any man with ED. In the past, few patients have undergone IPP following cystectomy, perhaps related to a perception of difficulty or increased risks of the procedure. Clinicians at the center reviewed the experience with placement of an IPP in this setting and compared it with results using an IPP for other indications. After matching, 231 patients were identified for the study with 33 patients having undergone cystectomy, 100 undergoing a radical prostatectomy, and 98 with organic ED of other etiologies. Urinary diversion in the cystectomy group was accomplished with orthotopic neobladder in 52%, ileal conduit in 36%, and continent-cutaneous diversion in 12%. Both 2-piece and 3-piece devices were used. There was an increased risk of 90-day complications in the RC group (24% vs 9%), with a statistically significant difference in Clavien-Dindo grade >3 complications between the groups. There were 6 superficial site infections in the cystectomy group, but none required device removal. The cystectomy group had a higher rate of IPP removal or replacement in the cystectomy group (21% vs 7%), with no difference in time to reoperation (8-10 years) between groups.