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Post-prostatectomy incontinence can be a significant complication of surgical treatment for prostate cancer, greatly affecting patient quality of life and social interaction. It is a complication, however, that can improve over time and has various treatment modalities available depending on its extent and bother to the patient. For the urologist, it is important to know exactly what options exist and their level of efficacy in order to appropriately council patients. The treatment options vary based on their levels of invasiveness, reported success, and potential complications. Some of the options are also better suited to specific degrees of incontinence. As a result, this enables the physician to set realistic expectations for their patients and offer the best care possible.

Surgical treatment for organic erectile dysfunction (ED) includes penile arterial revascularization, surgery for veno-occlusive dysfunction, and penile prosthesis implantation. In the 2005 American Urological Association Erectile Dysfunction Guidelines, surgery for veno-occlusive dysfunction was not recommended, and evidence to demonstrate efficacy for penile arterial revascularization was deemed to be lacking.

Erectile dysfunction (ED) after treatment for prostate cancer (radical prostatectomy, radiotherapy, or androgen deprivation therapy) is common. Systemic therapy with the PDE5 inhibitors is successful in a lower percentage of these patients than it is in men with ED of other etiologies. Penile injection therapy often results in usable erections in these men but its acceptability may be limited because of pain which is more common in this subset of patients. Vacuum erection device therapy and penile prosthesis implantation are non-pharmacologic options available for the treatment of ED after prostate cancer therapy.

Chronic pain after genitourinary prosthesis (penile, artificial urinary sphincters, and testicular) implantation is most often associated with infection or erosion. Management of infected or eroded devices requires device removal. Chronic pain in the absence of infection or erosion is rare.

Artificial urinary sphincter (AUS) implantation is most often performed to treat urinary incontinence following radical or subtotal prostatectomy. In these cases, the cuff of the AUS is placed around the bulbous urethra. This device can also be implanted to treat urinary incontinence associated with myelodysplasia in men, women, or children or to treat urinary incontinence caused by intrinsic sphincter deficiency in women. In these cases, the cuff is implanted around the bladder neck. This chapter details the implantation of the AUS with cuff placement around the bulbous urethra.