Two of the most common concerns among men in their 60s and 70s who visit a urology clinic are erectile dysfunction and urinary symptoms. Some patients improve with medication alone, while others require surgical treatment. Among those who need surgery, many ask whether both conditions can be treated at the same time—specifically, whether surgery for benign prostatic hyperplasia (BPH) and erectile dysfunction can be performed in a single procedure.
To answer this, it is important to first understand each treatment.
When erectile dysfunction does not respond to medications or conservative therapy, penile implant surgery may be considered. This procedure involves inserting a prosthetic device into the corpora cavernosa of the penis to enable an erection. There are two main types of penile implants: inflatable implants and malleable (semi-rigid) implants. Both types function by placing cylindrical devices inside the penile tissue to restore erectile function.
Treatment for benign prostatic hyperplasia includes both medical and surgical options. When surgery is required, several procedures are available, including holmium laser enucleation of the prostate (HoLEP), prostate urethral lift (UroLift), Aquablation (robotic waterjet surgery), and transurethral resection of the prostate (TURP). These procedures are typically performed endoscopically through the urethra.
An important consideration is that patients planning penile implant surgery should undergo a prostate evaluation beforehand if they experience significant urinary symptoms. Penile implant surgery involves placing a device within the penile erectile bodies, while BPH surgery requires inserting instruments through the urethra.
If a penile implant is already in place, it may compress surrounding structures and make it difficult for surgical instruments to pass through the urethra. Even if insertion is possible, the length and position of the implant can limit the reach of the endoscope, making it difficult to fully remove enlarged prostate tissue. In some cases, the implant may need to be removed temporarily to allow prostate surgery to be performed, and then reinserted afterward.
For this reason, patients who have urinary symptoms should undergo prostate evaluation before penile implant surgery to determine whether BPH treatment is needed first.
If urinary symptoms are mild and manageable with medication, penile implant surgery can proceed as planned. However, if surgical treatment for BPH is required, there are two approaches. Prostate surgery can be performed first, followed by penile implant placement after recovery, or both procedures can be performed during the same surgical session.
When HoLEP is chosen for prostate treatment, combined surgery is often feasible. In such cases, HoLEP is typically performed first, followed by penile implant surgery.
HoLEP usually takes about one hour, and penile implant surgery also takes approximately one hour. Including anesthesia and recovery time, the total procedure generally takes about two to three hours. Patients can typically be admitted in the morning, undergo surgery, and be discharged later the same day. Therefore, combined surgery is not necessarily as burdensome as many patients initially expect.
As men age, urologic conditions such as erectile dysfunction and urinary problems can significantly affect quality of life. With proper evaluation and individualized treatment planning, both conditions can often be managed effectively—sometimes even in a single surgical session.