Penile Prosthesis Implant: Treatment and Clinical Indications

A penile prosthesis It is a surgically implanted medical device indicated for men seeking an alternative functional, predictable and long-term for erectile dysfunction. According to the most recent updates to the guidelines of European Association of Urology (EAU 2025) And then American Urological Association (AUA), the penile implant is considered the reference surgical treatment in cases where conservative methods do not show the desired results or when, after adequate information, the patient preference It is for a definitive solution.

In practical terms, the penile prosthesis implant offers fundamental differentials for sexual health:

• Restoration of penile rigidity: provides sufficient rigidity for shape penetration controlled and predictable.

• Independence of the vascular response: unlike oral therapies, the functioning of the device does not depend on natural blood flow, being effective even in cases of advanced diabetes or severe vascular disease.

• Reduction of drug dependence: can eliminate the need for the recurrent use of pills or intracavernosal injections before sexual intercourse.

• Preservation of sensory functions: the procedure is designed to do not alter sexual desire (libido), penile sensitivity, orgasm, or ejaculation.

• High satisfaction rates: when there is a precise clinical indication and realistic alignment of expectations, studies demonstrate rates of satisfaction scores above 90% in selected patient groups.

Indications and shared decision-making

The choice for the implant of penile prosthesis is based on a process of shared decision-making between doctor and patient, based on scientific criteria validated by major global guidelines, such as AUA, a UAE and a ICSM (International Consultation on Sexual Medicine — a global panel of experts that defines treatment standards in sexual medicine).

Treatment may be indicated in different clinical scenarios, including:

• Refractory erectile dysfunction to first- and second-line treatments (oral medications or injections).

• Sexual rehabilitation after radical prostatectomy (prostate surgery).

• Peyronie's disease associated with the loss of penile rigidity.

• Cases of erectile tissue fibrosis or sequels of priapism.

• Patients who, after proper evaluation and full understanding of the risks and benefits, choose the implant as a strategy to resume their sexual spontaneity.

How does the penile prosthesis work?

A penile prosthesis replaces the natural erection mechanism by providing mechanical stiffness to the corpora cavernosa. The device is surgically implanted inside the penis and allows for predictable sexual intercourse, regardless of the vascular or neurological response.

Key points for understanding the patient:

• The prosthesis does not cause spontaneous erection biological;

• Rigidity is achieved by direct device action;

• The implant does not interfere with sexual desire (libido), sensitivity, orgasm or ejaculation;

• The prosthesis remains completely internal, with no externally visible components.

There are different types of penile prosthesis, and the choice depends on clinical, anatomical, functional, and patient preference, within the scope of a shared decision-making.

A malleable penile prosthesis is composed of flexible metal rods implemented inside the corpora cavernosa, continuously maintaining the penis in a semi-rigid state. It is a widely established device, developed to provide penile support in a simple, functional, and predictable manner.

How it is constituted:

• Internal structure formed by flexible metal rods, responsible for supporting and positioning the penis;
• The stems are completely surrounded by medical silicone, material biocompatible which ensures comfort and natural adaptation to the fabrics.

How it works:

• The penis remains with constant stiffness, being available for sexual intercourse;
• The position is manually adjusted by the patient: forward during intercourse, and downward or to the side for greater discretion in daily life;
• There is no need to activate pumps or transfer liquids.

Main advantages:

• Direct operation, being the simplest option in terms of handling;
• Excellent alternative for patients with manual dexterity limitation or certain neurological conditions;
• It offers an effective and immediate solution for resumption of sexual life.

Aspects to consider:

• Resting aesthetics: due to maintaining continuous firmness, it presents lower visual naturalness when compared to the inflatable model;
• Perception in daily life: constant filling can generate a greater perception of the implant's presence under clothing;
• Sexual mechanics: presents lower volumetric expansion capacity (caliber gain) and lower axial rigidity (compressive strength) during sexual intercourse when compared to the inflatable prosthesis.

Who it is usually most recommended for:

• Patients who prioritize maximum simplicity and ease of use;
• Men with physical limitations that make it difficult to handle inflatable systems;
• Cases where the clinical or surgical history favors a device with a simpler structure.

Penile Prosthesis Surgery: How it works

The implant surgery of penile prosthesis (malleable or inflatable) is a well-established procedure in modern urology, performed by specialized surgeons and following rigorous safety protocols. Penile prostheses began to be implanted in the decade of 1970 and, since then, they have gone through a significant evolution in technology, surgical materials and techniques, making the procedure increasingly safe and predictable.

Understanding how the surgery is performed and how the recovery period takes place helps reduce anxiety and align realistic expectations regarding the treatment of severe erectile dysfunction.

Is penile prosthesis surgery safe?

Penile prosthesis surgery is considered a procedure planned, standardized, and secure, when correctly indicated and performed by a urologist experienced in prosthetic surgery. The implant is positioned totally inside the body, without any externally visible components, preserving the genital aesthetics.

The main concern related to any prosthetic surgery is risk of implant infection. Currently, this risk has been drastically reduced thanks to important advances:

• Prostheses with antibiotic-impregnated surfaces, or with the possibility of adding the antibiotic of choice, allowing local and prolonged release after implantation

• Perioperative antibiotic prophylaxis, with the use of intravenous and oral antibiotics according to updated protocols

• No-touch technique, surgical technique that avoids direct contact of the prosthesis with the skin during implantation

Scientific studies demonstrate that the infection rate, which was approximately 5,3% in the early 2000s, fell to 1.99% with the use of antibiotic-impregnated prostheses and for 0.441 TP3T in combination with the no-touch technique, making this complication today infrequent in specialized centers.

Type of anesthesia and length of hospital stay

In most cases, the surgery is performed with regional anesthesia (spinal anesthesia), which provides excellent pain control and a comfortable recovery. In specific situations, such as certain clinical comorbidities, it may be indicated general anesthesia, always following an individualized assessment.

• Length of stay: usually the patient remains hospitalized for about 24 hours after the end of the surgical procedure

• Use of drain: in cases where a scrotal drain is placed, hospital discharge occurs when drainage becomes low, which usually happens in 24 to 48 hours, which can be extended if necessary

• The priority is always discharge the patient safely, and not serving a fixed term of hospitalization

Upon discharge, the patient leaves the hospital walking independently or with minimal assistance, with clear instructions, prescribed antibiotics, anti-inflammatories, and pain relievers.

The inflatable prosthesis reservoir: where it is located and why it can vary

In inflatable penile prostheses, in addition to the cylinders implanted in the penis and the pump positioned in the scrotal sac, there is a internal reservoir that stores the saline solution responsible for penile rigidity.

Well most cases, the reservoir is placed using the traditional technique, being introduced through external inguinal ring and positioned in Retzius space, located above the bladder and behind the pubic bone. This is a well-established, safe, and widely used technique.

However, in patients who have already undergone radical prostatectomy or to other surgeries in the lower abdomen, there may be significant fibrosis in this region. In these cases, to increase the safety of the procedure, the reservoir can be placed by a extra-anatomical bypass.

In extra-anatomic placement:

• the reservoir is positioned posterior to the rectus abdominis muscle and anterior to the transversus fascia

• The insertion is usually made in the lower abdomen

• This technique prevents areas of fibrosis and reduces surgical risks.

In general, the reservoir It is not palpable or visible externally. In very exceptional situations — usually in extremely thin patients — there may be some local perception of the reservoir, but that is rare and does not interfere with the functioning of the prosthesis.

The choice of the reservoir position is made in an individualized way, Taking into account the patient's surgical history, anatomy, and local conditions, always with a focus on safety, comfort, and a good functional outcome.

Post-operative care of the penile prosthesis: what to expect

Important details of the immediate postoperative period

• The surgery is performed by a single penoscrotal incision

• There are no traditional bandages because it is used surgical skin glue

• There are no withdrawal points later on

• Even in more complex cases — such as Peyronie's disease or associated reconstructions (including auxetic technique) — the entire procedure is carried out through the same incision, Including the placement of the reservoir of the inflatable prosthesis

What to expect in the first few days after surgery

The postoperative period requires relative rest and close monitoring. It is common to observe:

• Edema (swelling): It can persist for 15 to 60 days, It varies according to the extent of the surgery and the presence of associated reconstructions

• Equimosis (reddish spots): Common and expected, unlike a hematoma

• Local discomfort: usually well controlled with prescribed analgesics and anti-inflammatories

These changes are temporary and tend to regress progressively over time.

Probe, drain and special features according to the type of prosthesis

• Inflatable prosthesis:

  • The patient leaves the surgery with the prosthesis initially swollen, vesical probe e scrotal drain

  • In the hospital setting (usually 24 hours after the procedure), the prosthesis is drained, the urinary catheter is removed, and the drain is removed when drainage is minimal.

• Flexible prosthesis (semi-rigid):

  • In general, There is no need for a drain

  • The bladder probe is also removed before hospital discharge

Return to activities and sexual life

The deadlines below are Average estimates and vary according to the type of prosthesis, the implementation of associated reconstructions, and the individual conditions of each patient:

• Administrative activities: usually after return 7 days

• Physical activities: release after at least 30 days, It can be postponed in some cases, especially when the reservoir is positioned in the inguinal region.

• Sexual relations: usually released between 6th and 8th weeks, respecting the time required for complete healing and adaptation to the implant

Medical follow-up Weekly after the operation It is fundamental to guide each stage, adjust behaviors, and ensure safety, proper adaptation, and the long-term success of the treatment.

Post-implant follow-up and durability

The penile prosthesis is a medical implant of long duration, Developed to offer a reliable solution for severe erectile dysfunction. Medical follow-up after implantation is recommended to ensure security, adequate adaptation e checking functionality over time.

There are different models, technologies, and materials among the prostheses currently available. For this reason, guidelines regarding durability, expectations, and specific characteristics of each implant are discussed in detail. individualized during the medical consultation, Considering the clinical profile and surgical history of each patient.

Explaining Videos about Penis Prosthesis

Below you will find objective and enlightening videos about the main topics related to penile prosthesis, explained in a straightforward manner by the Dr. Alexandre Miranda, MD, PhD , Urologist specializing in the implantation of penile prostheses and genital reconstruction.