Best Age to Consider Getting a Penile Implant

According to the 2025 EAU Guidelines, there is no specific “best age” to consider getting a penile implant, as the decision should be guided by clinical factors rather than chronological age.¹ Penile implants are considered a third-line treatment option for erectile dysfunction (ED) and are typically recommended when patients are not suitable for or have not responded adequately to less invasive treatments such as oral medications, vacuum devices, or injection therapies.² ³ The EAU Guidelines identify two main types of penile implants available for patients: inflatable (two- and three-piece) and semi-rigid devices.⁴ The three-piece inflatable implants provide the most natural erection, while semi-rigid implants offer advantages including a simpler implantation technique and easier use for patients with limited manual dexterity.⁵ The choice between these options should be based on a thorough discussion between the physician and patient, with the patient ultimately making the final decision about which type best suits their needs.⁶ Patient satisfaction is a key consideration when determining the timing for penile implant surgery. The EAU Guidelines note that regardless of the indication, prosthesis implantation has one of the highest satisfaction rates among ED treatments, with high levels of satisfaction reported by both patients and their partners after penile implant surgery.⁷ This high satisfaction rate should be considered when weighing treatment options at any age. The guidelines emphasize that surgical approaches for implantation should be chosen based on surgeon experience and patient anatomy rather than age.⁸ Both peno-scrotal and infrapubic approaches are recognized, with no specific advantage of one over the other identified in the guidelines.⁹ The recommendation is that surgeons use the approach with which they are most comfortable and experienced. Potential complications that should be considered when determining the timing for penile implant surgery include mechanical failure and infection.¹⁰ The guidelines note that infection rates have decreased significantly with the use of antibiotic-impregnated or hydrophilic-coated prostheses.¹¹ Patients with certain conditions, such as spinal cord injuries, may have a higher risk of complications, with up to 16% reporting prosthesis infection in published series.¹² These factors should be carefully evaluated when considering the appropriate timing for implantation, regardless of age. In conclusion, the 2025 EAU Guidelines suggest that the decision to proceed with penile implant surgery should be based on individual clinical factors, treatment history, and patient preference rather than age alone. Penile implants remain a highly effective option for patients with erectile dysfunction who have not responded to or are not suitable for less invasive treatments, with high satisfaction rates reported across age groups.¹³