How Does a Penile Prosthesis Work?

A penile prosthesis (also known as a penile implant) is a medical device implanted into the penis to allow men with erectile dysfunction (ED) to achieve an erection suitable for sexual intercourse. It is typically recommended when other treatments like medications, vacuum erection devices, or other less invasive options have proven ineffective or are not suitable for the patient.

There are two main types of penile implants:

Inflatable Penile Prosthesis (IPP): This is the most common type and consists of three components—two inflatable cylinders placed inside the penis, a fluid reservoir implanted in the abdomen, and a pump located in the scrotum. To achieve an erection, the patient squeezes the pump, transferring fluid from the reservoir into the cylinders. To return to a flaccid state, a deflation valve is pressed, allowing the fluid to flow back to the reservoir. This system creates a natural-feeling erection and allows the penis to return to a flaccid state afterward.

Semi-rigid (Malleable) Prosthesis: This device consists of bendable rods inserted into the penis. The penis remains semi-firm at all times and can be manually positioned for sexual activity. This option is simpler and may be more suitable for men with limited manual dexterity or specific health conditions.

Penile implants are effective and durable, with satisfaction rates reported between 80% and 90% in patients and 75% to 85% in partners. Mechanical reliability is high with modern devices, though not perfect. For example, the mechanical survival rate of three-piece implants is approximately 81.3% at 10 years.

There are risks, as with any surgery, including infection, device malfunction, and discomfort. Infection risk is minimized with antibiotic-impregnated or hydrophilic-coated implants and proper surgical technique. The prosthesis typically has good longevity, with 10-year revision-free survival rates of 79.4% for malleable devices and 74.9% for inflatable devices.

This procedure can also be used in specific cases of Peyronie’s disease with ED or for men who experience priapism that has led to penile damage. However, patients should be counseled that penile lengthening should not be expected from the prosthesis itself, although some surgical techniques may help preserve length in cases of penile fibrosis.

Ultimately, the decision to get a penile prosthesis is personal and should be guided by a urologist, taking into account patient preferences, medical history, and manual ability.