Can I Have a Penile Implant After Prostatectomy, Cystectomy or Kidney Transplant?

Yes, in many cases, although previous surgery can influence which type of implant is chosen. According to the 2026 EAU Guidelines, pelvic surgery, especially for cancer, such as radical prostatectomy, radical cystectomy and colorectal surgery, may have a negative impact on erectile function and overall sexual health.¹ Surgery that damages the neurovascular bundles controlling the erectile response may result in erectile dysfunction, although nerve-sparing approaches have been adopted over the last few decades.²

After radical prostatectomy, oral PDE5 inhibitors are considered the first-line therapy in patients who have undergone nerve-sparing surgery,³ and intracavernous injections and penile implants are suggested as second-line and third-line treatments, respectively, when oral medicines are not effective enough or are not suitable.⁴ More generally, a penile prosthesis may be considered in patients who are not suitable for other drug treatments or prefer a definitive therapy, and who do not respond to other treatments.⁵

Previous surgery matters mainly because of the reservoir of a three-piece inflatable implant, which is placed in the lower abdomen. The EAU Guidelines note that non-infectious reservoir complications, including injury to the bladder, bowel and blood vessels, have been described,⁶ and that a two-piece inflatable prosthesis can be a viable option for patients at high risk of complications with reservoir placement, such as after previous abdominal surgery.⁷

The American Urological Association (AUA) guideline gives similar advice: for men in whom an abdominal reservoir may pose a risk, such as those with extensive scarring or a kidney transplant, a two-piece inflatable model may be considered if a hydraulic device is desired.⁸

Semi-rigid implants, which have no reservoir, are another option; they offer a simple implant technique and easy use, but can cause an unnatural persistent erection and reduced concealability.⁹

Infection is one of the two main complications of implant surgery, and with careful surgical technique and appropriate antibiotic prophylaxis, infection rates have been reduced to 2–3% for primary implantation in low-risk patients and in high-volume centres.¹⁰ The AUA guideline adds that penile prosthesis surgery should not be performed in the presence of systemic, skin or urinary tract infection.¹¹

Regardless of the indication, penile implants have one of the highest satisfaction rates among erectile dysfunction treatments, 92–100% in patients and 91–95% in partners, with appropriate counselling.¹²

Because every surgical history is different, whether an implant is suitable, and which type, should be decided by the patient and his surgeon together after a full review of previous operations.