Who is a candidate for a penile implant?

Penile prosthesis implantation is a viable treatment for men experiencing erectile dysfunction (ED), especially when other conservative therapies fail. According to EAU and AUA guidelines, candidates are men who do not benefit from oral PDE5 inhibitors (e.g., sildenafil), intracavernosal injections, or vacuum erection devices. This also includes patients who prefer a long-term, mechanical solution over ongoing medical therapy.

Typical candidates include those with advanced diabetes mellitus, post-prostatectomy ED, spinal cord injuries, or Peyronie’s disease with significant penile deformity. In cases where priapism or severe corporal fibrosis occurs, immediate or delayed implantation may also be advised to restore sexual function.

The decision to proceed with implantation involves shared decision-making between the patient and the urologist, including a thorough review of expectations, surgical risks, and postoperative care. Psychological counseling may also be beneficial to align patient and partner expectations.

There are two primary types of implants: inflatable (two- or three-piece) and malleable (semi-rigid) prostheses. The choice depends on the patient’s physical condition, manual dexterity, and personal preference. While inflatable types offer a more natural erection and better concealment, malleable implants are simpler to use and may be preferable in patients with limited mobility or dexterity.

Success and satisfaction rates for penile implants are high. Studies report patient satisfaction between 90–98%, with comparable rates in partners. The surgical outcomes are durable, and with proper technique and device selection, infection rates remain under 3% in primary cases.

It’s crucial that men considering this treatment understand that while implants restore rigidity, they do not affect penile sensitivity, ejaculation, or orgasm. Most men are able to resume sexual activity within 4–8 weeks post-surgery after proper healing and instruction.