What is the Phantom Technique?

The Phantom Technique, clinically referred to as the infrapubic approach, is a surgical method used for the implantation of a penile prosthesis, a medical device designed to treat erectile dysfunction (ED)¹. Penile prostheses are recommended for individuals with ED who are not candidates for or have not responded to other treatments, such as oral medications or injections, or for those who prefer a permanent solution². According to the 2025 EAU Guidelines on Sexual and Reproductive Health, this treatment has one of the highest satisfaction rates among all ED therapies, with 92-100% of patients and 91-95% of their partners reporting satisfaction when appropriate counseling is provided².

There are two main types of penile implants available: inflatable devices (two- or three-piece) and semi-rigid (malleable) rods³. Three-piece inflatable devices are often preferred by patients because they provide a more natural-feeling erection and flaccidity³. Semi-rigid rods, while simpler to implant and use, result in a permanently firm penis that may be less concealable³. The choice of implant depends on individual patient factors, including anatomy, medical history, and personal preference. The EAU Guidelines state that there is no definitive evidence to suggest that one type of implant is superior to another in terms of mechanical reliability or patient satisfaction³.

The Phantom (infrapubic) Technique involves a small incision in the lower abdomen, just above the pubic bone, to access the corpora cavernosa—the two chambers of spongy tissue inside the penis that fill with blood to create an erection. The implant is then inserted through this incision. The alternative surgical approach is the peno-scrotal incision, which is made on the scrotum¹. A systematic review cited in the EAU Guidelines found no significant advantage of one surgical approach over the other in terms of satisfaction or complication rates¹. Therefore, the choice of surgical technique is typically based on the surgeon’s expertise and the patient’s specific anatomy and needs¹.

It is important for patients to have realistic expectations regarding the outcomes of penile implant surgery. While the primary goal is to restore the ability to achieve an erection suitable for sexual intercourse, the implant does not increase penile length or girth. In fact, the EAU Guidelines note that some patients may perceive a decrease in penile length after the procedure, although objective measurements often show no significant change⁴. The guidelines emphasize that penile prosthesis implantation is not a procedure for penile lengthening⁴.

The risks associated with penile prosthesis implantation include mechanical failure and infection. However, modern devices have low mechanical failure rates, with less than 5% at 5 years of follow-up⁵. Infection rates are also low, typically between 2-3% for primary implantations in low-risk patients, and can be further reduced to 1-2% with the use of antibiotic-coated or hydrophilic-coated implants⁶. Adherence to strict surgical protocols and appropriate antibiotic prophylaxis are critical for minimizing these risks⁶.

Long-term durability data from the EAU Guidelines shows that penile implants have excellent survival rates, with 93.3% functioning 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 years⁵. These statistics demonstrate that penile prostheses are a reliable long-term solution for erectile dysfunction. The guidelines emphasize that there is sufficient evidence to recommend this approach for patients who do not respond to less-invasive treatments due to its high efficacy, safety, and satisfaction rates².

Patient counseling is essential before and after penile implant surgery. The EAU Guidelines recommend that patients be fully informed of the benefits and risks associated with the procedure². Focused psychosexual counseling may improve sexuality and sexual well-being for both patients and their partners after surgery². Common patient concerns that should be addressed include realistic expectations about penile size, the permanence of the procedure, the need for device activation (in inflatable models), and the potential for future surgical revisions. Patients should understand that while the implant restores the ability to achieve an erection, it does not affect sensation, orgasm, or ejaculation².