What Is the Best Age for a Penile Implant?

According to the 2025 EAU Guidelines, penile implants (also called penile prostheses) are not age-restricted but rather are recommended based on specific clinical criteria. The guidelines indicate that surgical implantation of a penile prosthesis may be considered in patients who are not suitable for different pharmacotherapies or prefer a definitive therapy, and who do not respond to other treatment modalities. Age alone is not a determining factor in the decision-making process.

The EAU Guidelines describe two main classes of penile implants available for patients with erectile dysfunction: inflatable (two- and three-piece) and semi-rigid devices (malleable, mechanical, and soft flexible). There are currently no head-to-head studies comparing different manufacturers’ implants that demonstrate superiority of one implant type over another. This means that the choice of implant should be based on the patient’s anatomy, manual dexterity, and surgeon’s recommendation rather than the patient’s age.

For patients considering penile implants, it’s important to understand that this option is typically considered a third-line treatment after other options have failed. The guidelines state that penile implants should be offered to patients with erectile dysfunction who do not respond to pharmacotherapy. This recommendation applies to adult men of any age who meet these criteria, though the patient’s overall health status and life expectancy may factor into the decision-making process.

Regarding outcomes, the EAU Guidelines report that regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92-100% in patients and 91-95% in partners) among the treatment options for erectile dysfunction when appropriate counseling is provided. These high satisfaction rates appear to be consistent across age groups, though the guidelines do not specifically stratify outcomes by patient age.

The two main complications of penile prosthesis implantation are mechanical failure and infection. Several technical modifications of commonly used three-piece prostheses have resulted in mechanical failure rates of less than 5% after 5 years of follow-up. 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. These long-term durability statistics may be particularly relevant for younger patients considering this treatment option.

The EAU Guidelines emphasize that focused psychosexual counseling may improve sexuality and sexual well-being in both patients and their partners after penile implant surgery. There is sufficient evidence to recommend this approach in patients who do not respond to less-invasive treatments due to its high efficacy, safety, and satisfaction rate, regardless of the patient’s age.