Penile Implants: Who Needs One, What the Surgery Involves, and Long-Term Results
For men with severe erectile dysfunction that has not responded adequately to medication or other treatments, a penile implant (prosthesis) offers the most reliable and durable solution available. Patient satisfaction rates with modern three-piece inflatable implants consistently exceed 90% — among the highest of any surgical intervention in urology.
Despite this, penile implant surgery remains poorly understood by patients and underreferenced by GPs and generalist urologists. Many men who are ideal candidates are never offered this option.
What Is a Penile Implant?
A penile implant is a medical device implanted inside the penis that allows a man to achieve an erection on demand. There are two main types:
Inflatable (three-piece) implants — the most commonly used type. Three components are implanted: two cylinders inside the penis, a reservoir of saline solution placed behind the pubic bone, and a pump placed in the scrotum. To achieve an erection, the patient squeezes the scrotal pump to transfer fluid from the reservoir into the cylinders. To deflate, a release valve is activated. When inflated, the penis looks and feels natural — firm enough for intercourse and indiscernible as a prosthesis by a partner who is not told.
Malleable (semi-rigid) implants — two flexible rods are implanted inside the penis, which is manually positioned as needed. Simpler to use and more durable, but the penis remains permanently semi-rigid (though can be bent downward when not in use). Generally preferred for men with reduced manual dexterity or cognitive ability, or for certain body types.
Who Is a Candidate for a Penile Implant?
Penile prosthesis implantation is recommended for men with:
- Severe ED that has not responded adequately to PDE5 inhibitors, injection therapy, or vacuum devices
- ED following radical prostatectomy for prostate cancer
- ED associated with Peyronie's disease (implant both straightens and restores erectile function)
- ED caused by diabetes mellitus with neurological or vascular involvement
- ED following pelvic radiotherapy
- Priapism-related fibrosis
It is also appropriate for men who prefer a definitive solution over the ongoing use of on-demand medication.
The Surgical Procedure
Penile implant surgery is performed under general or regional anaesthesia and typically takes 60–90 minutes. Professor Minhas and Professor Yap are high-volume implant surgeons whose technical experience is among the most extensive in the UK.
During surgery, the erectile tissue (corpora cavernosa) is dilated, and the cylinders are placed within them. The pump and reservoir are then positioned and the system is connected. The incision is typically small and placed at the base of the penis or the junction between the scrotum and the shaft.
Most patients are discharged the same day or the following morning. The implant can be activated (and intercourse resumed) approximately four to six weeks post-operatively, once healing is complete.
Risks and Complications
Like all surgery, penile implant surgery carries risks. The most significant concern is infection. Modern implants have antibiotic coatings that have substantially reduced infection rates — in primary (first-time) implant surgery in experienced centres, infection rates are approximately 1–3%. If infection occurs, the implant must be removed, and revision surgery can be performed once the infection has resolved.
Mechanical failure of the device occurs in approximately 5–10% of cases over 10 years. Modern implants carry a lifetime warranty from the manufacturer.
Satisfaction rates are very high. In series published by experienced implant surgeons, over 90% of men and their partners report satisfaction with the result.
The Importance of Surgical Experience
Outcomes in penile prosthetic surgery are highly volume-dependent. Complication rates, revision rates, and patient satisfaction are all significantly better in the hands of high-volume implant surgeons. When considering this surgery, the most important question to ask is how many implants the surgeon performs each year.
