Patient-reported penile sensory loss, not surgical approach, is associated with sexual satisfaction after inflatable penile prosthesis implantation

Abstract Background Postoperative penile sensory changes are frequently reported after penile prosthesis implantation, yet their impact on sexual satisfaction remains unclear. Aim To determine whether patient-reported penile sensory loss independently predicts postoperative sexual satisfaction and to compare outcomes between penoscrotal and infrapubic approaches. Methods This retrospective single-center observational study included 159 men undergoing three-piece inflatable penile prosthesis (IPP) implantation with ≥9 months of follow-up; patients with neurological conditions affecting genital sensation were excluded. Clinical, hormonal, Doppler, perioperative, and postoperative data were collected, sexual satisfaction was assessed using the New Sexual Satisfaction Scale (NSSS), and penile sensory loss was evaluated separately using a single-item binary patient-reported question administered during face-to-face interviews (“Do you currently experience loss of penile sensation?”), reflecting present postoperative perception. Predictors of NSSS were analyzed using univariate and multivariate linear regression, and outcomes between surgical approaches were compared using Mann–Whitney U, Chi-square, or Fisher’s exact tests. Outcomes The primary outcome was postoperative sexual satisfaction (NSSS), and secondary outcomes included penile sensory loss, operative time, hospital stay, Clavien–Dindo complications, and prosthesis malfunction. Results Penile sensory loss was the only independent predictor of lower NSSS scores (β = −17.72; 95% CI −22.13 to −13.31; P .001), while age, BMI, Charlson Comorbidity Index, erectile dysfunction etiology, smoking exposure, complications, and device malfunction were not independently associated with satisfaction (all P .05). No significant differences were observed between penoscrotal and infrapubic approaches in postoperative sensory loss (P = .234), NSSS scores (P = .181), operative time (P = .170), or hospital stay (P = .406), although the penoscrotal approach showed a higher overall rate of Clavien–Dindo complications (76.5% vs. 43.5%, P .001), this difference was predominantly driven by low-grade (Grades I-II) events rather than clinically severe complications, with identical malfunction rates between groups (17.6% vs. 17.6%). Clinical Implications Penile sensory perception significantly influences postoperative sexual satisfaction and should be routinely evaluated. Strengths and Limitations Strengths include a relatively large cohort and use of a multidimensional validated satisfaction measure, while limitations include the retrospective design, reliance on subjective sensory reporting, and absence of long-term follow-up. Conclusion Patient-reported penile sensory perception showed the strongest independent association with sexual satisfaction after IPP implantation, while surgical approach was not significantly associated with either sensory outcomes or overall satisfaction.