Major pelvic urological surgery (radical prostatectomy and radical cystectomy) and genital oncological surgery in the male patient can cause postsurgical sexual dysfunction. It is becoming increasingly important in the patientʼs view as a result of improved cancer prognosis, refinements in surgical technique, and increased awareness of quality of life aspects that involve sexual satisfaction. Besides the aesthetic aspects related to penis amputation in glans or penis tumor, the pathophysiology of the problem is essentially related to the disruption of the nerves during the procedure, both cavernous nerves during radical prostatectomy or cistectomy and simpathetic chains during retroperitoneal lymph nodes dissection. Moreover, a vascular impairment may also be advocated. Nerve-sparing surgery enables the recovery and/or maintenance of sexual functioning in a significant proportion of patients. In case of glans or penile tumor, a sexsparing surgery could preserve both erectile function and the aestethic, but when a complete amputation is necessary, a phalloplasty with penile prosthesis implantation coul restore the possibility of sexual intercourses. A number of erectile aids are available to treat postsurgical male erectile dysfunction successfully. Sexual riabilitation can be achieved in these patients with the first-line medical therapy (as oral PDE-5 inhibitor or intracavernous injecton) surgical approach, by implantation of penile prosthesis.