Penile prosthesis implantation for patients with comorbid severe premature ejaculation and erectile dysfunction: a pilot cohort study

Premature ejaculation (PE) and erectile dysfunction (ED) commonly show a bidirectional association. Pharmacological treatments for PE often result in high dropout rates due to limited efficacy and adverse events. Penile prosthesis implantation (PPI) is considered a definitive treatment for ED. This study evaluated PPI's safety and efficacy in improving ejaculatory and erectile function in patients with severe PE and refractory-to-medical-treatment ED. Seven patients with severe lifelong PE and ED unresponsive to medical therapies underwent three-piece inflatable PPI via an infrapubic approach. Functional outcomes were assessed at a six-month follow-up using the International Index of Erectile Function (IIEF), the Premature Ejaculation Diagnostic Tool (PEDT) and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). At 6 months, the self-estimated intravaginal ejaculation latency time (IELT) improved significantly (mean 726.4 sec vs. 40.7 sec, p < 0.009; 95% CI: 1217.4; 153.9 sec), with reductions in PEDT scores (mean difference: -15.2, p < 0.0001; 95% CI: -11.6; -18.8) and improvements in MSHQ-EjD scores (mean difference: 5.5, p < 0.02). IIEF-EF scores increased by 14 points (p < 0.001; 95%CI: 21.1; 6.8), with improvements in sexual desire, overall satisfaction, and intercourse satisfaction domains (all p < 0.04). PPI significantly improved both ejaculatory and erectile outcomes in patients with severe PE and resistant-to-medical-therapy ED. Larger studies are needed to confirm these findings.