Is There a Penile Implant Without a Separate Reservoir?

Yes. According to the 2026 EAU Guidelines, the two currently available classes of penile implants are inflatable devices, which come in two-piece and three-piece designs, and semi-rigid devices, which include malleable, mechanical and soft flexible types.¹ Only the three-piece inflatable implant uses a separate fluid reservoir placed in the lower abdomen; two-piece inflatable and semi-rigid implants do not need one.

The guidelines note that non-infectious reservoir complications, including injury to pelvic structures such as the bladder, bowel and blood vessels, have been described.² For this reason, the EAU Guidelines state that the two-piece inflatable prosthesis can be a viable option for patients who are deemed at high risk of complications with reservoir placement, for example after previous abdominal surgery.³

Semi-rigid prostheses do not need to be inflated at all. They result in a firm penis that can be manually placed in an erect or flaccid position, and they offer the advantage of a simple implant technique as well as easy use for the patient.⁴ Their disadvantages are an unnatural, persistent erection and reduced concealability, although they may also be an option for men with limited manual dexterity.⁵

By comparison, some patients prefer three-piece inflatable devices because of the more “natural” erections they provide, although no prospective randomised trials have compared satisfaction rates between implant types.⁶ There are currently no head-to-head studies comparing different manufacturers’ implants or showing that one implant type is superior to another.⁷

Whichever design is chosen, the two main complications of penile implant surgery are mechanical failure and infection.⁸ With careful surgical technique and appropriate antibiotic prophylaxis, infection rates have been reduced to 2–3% for primary implantation in low-risk patients and in high-volume centres.⁹ A meta-analysis cited in the guidelines reported implant survival rates of 87.2% at five years and 76.8% at ten years.¹⁰

Regardless of the indication, penile prosthesis implantation has one of the highest satisfaction rates among erectile dysfunction treatments, reported at 92–100% in patients and 91–95% in partners, when appropriate counselling is provided.¹¹ The guidelines add that a penile implant may be considered for men who are not suitable for other drug treatments or who prefer a definitive therapy, and who do not respond to other treatment options.¹²

The choice between a three-piece, two-piece or semi-rigid implant should be made by the patient and his surgeon together, taking into account previous surgery, manual dexterity and personal preference.