REVIEWS A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients Brian Dick, BS, Jacob W. Greenberg, BS, Michael Polchert, MS, Caleb Natale, BA, Wayne J. G. Hellstrom, MD, and Omer A. Raheem, MD ABSTRACT Introduction: There is an increased prevalence of erectile dysfunction in patients with solid organ transplant (SOT) compared with the general population. Many of these patients may become refractory to medical treatment of erectile dysfunction and penile prosthesis (PP) is often recommended. Concerns regarding the safety of PP in patients with SOT are due to their immunosuppressed state. Objective: We aim to review all current literature on the outcomes of patients with SOT who have received PP. Methods: A PubMed search was performed to identify articles pertaining to the outcomes of PP in patients with SOT. Results: We identified and included 14 studies that report on outcomes of PP placement in 143 patients with SOT and 191 non-SOT controls from interval period from 1979 to 2019. Studies included retrospective cohort studies, case series, and case reports. Compared with non-SOT controls who had PP, aggregate analysis demonstrated that patients with SOT who had PP did not develop significantly increased overall complications. However, they were significantly more likely to experience future surgical complications. Conclusion: Our aggregate analysis demonstrated that patients with SOT are not at a significantly increased risk of overall complications when receiving a PP. Nevertheless, there is an increased risk of experiencing PP injury during subsequent surgeries, which may be mitigated by the earlier involvement of a urologist. Given the lack of recent data, large studies are prerequisite to further evaluate the safety and overall outcome of PP surgery in patients with SOT. Dick B, Greenberg JW, Polchert M, et al. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2020;XX:XXXeXXX. Copyright Ó 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Penile Prosthesis; Organ Transplant Recipients; Review; Outcomes; Surgery INTRODUCTION The magnitude of solid organ transplant (SOT) recipients has been continuously increasing worldwide. For example, in 2018, more than 30,000 transplants were performed in the United States. 1 Many patients who receive a kidney transplant likely have additional comorbidities such as diabetes, cardiovascular disease, hypertension, hypercholesterolemia, and uremia, which could ultimately contribute to erectile dysfunction (ED). 2 Moreover, it is estimated that the prevalence of ED in pa- tients with a liver, renal, and heart transplant is 40e86%, 54e66%, and 71e78%, respectively. 3 On the other hand, patients who require liver transplant may suffer from abnormal hormone levels, ie, hypogonadism, which interferes with appropriate sexual and erectile functioning. Prior studies have reported of a little return of erectile function for patients with SOT after transplant; however, it remains significantly worse than in healthy controls. 3 The current American Urological Association guideline does recommended discussing all available treatment options for ED in patients with SOT. These treatment options include phos- phodiesterase type 5 inhibitors, which may be are as efficacious as in the general population. Patients may also use intracavernosal injections. However, patients with SOT typically require higher doses than the general population and have less success with this method. 3 In selected patients with ED refractory to medical therapy, penile prosthesis (PP) is usually recommended as the treatment of choice. However, there are concerns of increased complications rates such as prosthetic infection in patients with SOT because of coexistent risk factors such as continuous immunosuppression. In orthopedic prosthesis procedures eg, knee and hip replacements, patients with SOT have been shown to have longer hospital stays, higher complication rates, and increased mortality when compared with non-SOT controls. 4e6 There is a paucity of data evaluating the complication rates of PP Received April 14, 2020. Accepted May 17, 2020. Department of Urology,Tulane University, New Orleans, LA, USA Copyright ª 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.sxmr.2020.05.006 Sex Med Rev 2020;-:1e5 1