What Are the Downsides of a Penile Prosthesis?

1. Surgical Procedure and Recovery: Implantation of a penile prosthesis requires a surgical procedure under general or spinal anesthesia. Patients typically need to refrain from sexual activity, including masturbation, for at least six weeks post-surgery. A small scar will be present, usually above the penis or between the penis and scrotum.

2. Risk of Infection: Even with modern surgical techniques and antibiotic-coated devices, infection remains a concern. Infection rates range from 1–3% in primary low-risk cases but can reach 6–30% in high-risk scenarios, such as emergency implantation after priapism. Risk factors include diabetes, spinal cord injury, and hypogonadism.

3. Mechanical Failure: Although modern three-piece implants are durable, mechanical failure can occur. Failure rates are below 5% after five years but rise over time, with device survival dropping to about 53% after 20 years. Revisions or replacements may eventually be necessary.

4. Additional Complications: Other risks include erosion of the implant through the skin or urethra (1–6%), reservoir-related injuries to nearby pelvic organs, and rare cases of glans necrosis (~1.5%). These complications are more common in patients with vascular issues or those undergoing additional lengthening procedures.

5. Satisfaction and Penile Length Concerns: Although satisfaction rates are high (92–100% in patients), some individuals—especially those with Peyronie’s Disease (PD)—report dissatisfaction due to perceived penile shortening. It’s important to note that implants are not designed to increase penile length. In fact, lengthening procedures like the “sliding technique” are discouraged due to high complication risks.

6. Special Considerations: For priapism-related ED, immediate prosthesis insertion is recommended but carries a higher infection risk. Semi-rigid implants, though simpler and cheaper, may result in permanent visible rigidity and reduced concealment.

Despite these potential downsides, penile prostheses do not affect the ability to achieve orgasm, ejaculate, or feel penile sensation. With proper patient selection and counseling, they remain one of the most satisfying and definitive treatments for ED.