Abstract Introduction Penile Prosthesis Implantation (PPI) is the established third-line therapy for refractory organic erectile dysfunction (ED), yet its use in refractory psychogenic ED has remained controversial due to historical concerns regarding patient satisfaction and psychological adjustment. Objective To systematically review and compare patient satisfaction, functional outcomes, and postoperative complication rates after PPI in men with refractory psychogenic ED (PSY) versus those with organic ED (ORG). Methods A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Web of Science. Inclusion criteria were studies providing outcome data (satisfaction, functional outcomes, or complications) for patients with psychogenic ED, particularly those comparing them to an organic ED cohort. Data on patient-reported satisfaction using validated tools (e.g., QolSPP, GAQ, SEP), functional outcomes, and postoperative complication rates were extracted and synthesized. Results A total of Five studies involving 159 PSY and 837 ORG patients were included in our study. Recent evidence shows high satisfaction in the PSY group, with 96% reporting successful erections (GAQ-1 success) and a mean satisfaction score of 8.7/10. Validated questionnaire data demonstrated that PSY patient satisfaction was statistically superior or comparable to the ORG cohort across multiple domains (improvement in 8 of 16 QolSPP questions, p0.05). Functional outcomes, including rates of successful vaginal penetration (SEP-2: 92%) and satisfactory intercourse (SEP-5: 95%), were similarly high in the PSY group. A consistent finding across both historical and contemporary studies was a significantly higher rate of postoperative complications in the PSY cohort. Recent data indicated complication rates of 16% in PSY versus 2.8% in ORG patients, while historical comparisons reported revision surgery in 100% versus 40% of patients, respectively. Reported complications included mechanical failure, fluid loss, bulging upon inflation, deflation failure, and device discomfort necessitating reoperation. Historical concerns of negative psychological sequelae such as postoperative decompensation or relationship instability were unsupported in appropriately screened patients. No significant changes in psychological well-being were noted postoperatively in either group when major psychopathology was excluded preoperatively. Conclusions PPI is a highly effective option for refractory psychogenic ED, yielding patient satisfaction levels that match or exceed those of organic ED patients. However, this benefit is contrasted by a consistently and significantly higher risk of postoperative complications and revision surgery in the PSY population. Therefore, while PPI should not be withheld from appropriately selected psychogenic ED patients, meticulous preoperative counseling to align expectations and explicit discussion of the higher surgical risk profile are essential. Rigorous psychiatric screening remains critical to optimize outcomes and minimize complications. Disclosure No
Hamdan et al. (Mon,) studied this question.