Is a Catheter Needed After Penile Implant Surgery?

Penile implant surgery, also known as penile prosthesis implantation, is a well-established and effective surgical treatment option for erectile dysfunction (ED) that does not respond to less invasive treatments.¹ The 2025 EAU Guidelines recognize penile prosthesis implantation as having high efficacy, safety, and satisfaction rates in appropriately selected patients.² While the guidelines provide comprehensive information about various aspects of penile implants, they do not specifically address whether catheterization is necessary during the post-operative period. The EAU Guidelines identify two main types of penile prostheses: malleable (semi-rigid) and inflatable (two- and three-piece) implants.³ Three-piece inflatable devices consist of paired cylinders implanted in the corpora cavernosa, a pump placed in the scrotum, and a reservoir located in the retropubic space. Two-piece inflatable devices have the pump and reservoir combined as a single unit positioned in the scrotum. Malleable implants consist of paired rods with internal metal cables or springs providing the rigidity needed for penetration.⁴ According to the guidelines, careful surgical techniques with appropriate antibiotic prophylaxis against Gram-positive and negative bacteria have reduced infection rates to 2-3% with primary implantation in low-risk patients and high-volume centers.⁵ The infection rate may be further reduced to 1-2% by implanting an antibiotic-impregnated prosthesis or a hydrophilic-coated prosthesis.⁶ However, the guidelines do not specify whether catheterization plays a role in reducing infection risk or facilitating postoperative recovery. The EAU Guidelines report that mechanical failure rates of modern three-piece prostheses are less than 5% after 5 years of follow-up.⁷ A meta-analysis showed implant durability or survival rates of 93.3% at 1 year, 91.0% at 3 years, 87.2% at 5 years, 76.8% at 10 years, 63.7% at 15 years, and 52.9% at 20 years.⁸ Post-operative care protocols, including any potential catheterization requirements, are not detailed in the guidelines. The guidelines emphasize that psychosexual counseling may improve sexuality and sexual well-being in both patients and their partners after penile implant surgery.⁹ This suggests that comprehensive post-operative care extends beyond physical recovery to include psychological support, though specific post-operative management protocols, including catheter use, are not outlined in the EAU Guidelines. For patients considering penile implant surgery, the guidelines recommend discussing all available treatment options and their potential complications with their healthcare provider.¹⁰ While the 2025 EAU Guidelines provide valuable information on many aspects of penile prosthesis implantation, decisions regarding post-operative catheterization would be based on individual surgeon preference, institutional protocols, and patientspecific factors rather than explicit guideline recommendations.