Penile prosthesis implantation following conservative surgical treatment for penile cancer: anatomical and surgical considerations

Penile prosthesis implantation following penile cancer surgery presents a unique set of challenges. While penile sparing surgery, such as glansectomy and partial penectomy, aim to preserve urinary and sexual function, erectile dysfunction remains a consequence due to tissue loss and psychological distress. This review explores erectile function outcome following glansectomy and partial penectomy and provides practical framework for penile prosthesis implantation in this context. Specific considerations include anatomical changes, surgical timing and approach, prosthesis choice, patient counselling, and follow-up care. The selection of a penile prosthesis device should be individualized. Oversizing should be avoided, and downsizing should be considered, particularly in cases with significant corporal fibrosis. Moreover, inflatable penile prostheses are generally preferred, but malleable devices remain useful in selected cases, particularly following partial penectomy to facilitate unburying of the penis. Surgical strategies must account for altered penile and urethral anatomy to avoid complications such as urethral injury and prosthesis erosion. Post-prosthesis cancer surveillance remains essential and should adhere to current guidelines for penile cancer. A multidisciplinary approach and tailored surgical planning are essential to achieve satisfactory outcomes while maintaining oncological safety.