Penile Prosthesis (Penile Implant) Surgery

Erectile dysfunction is the inability to achieve or maintain an erection sufficient for intercourse. Treatment follows a stepwise approach: first lifestyle and, where relevant, hormonal adjustment, then oral medication (PDE5 inhibitors), and after that intracavernosal injection or a vacuum device.

A penile prosthesis is the surgical solution considered when these steps do not give a sufficient result. Cylinders that provide rigidity are placed inside the spongy tissue of the penis responsible for erection (corpus cavernosum). The device gives a rigidity the patient controls and can use whenever he wishes.

AN IMPORTANT AND PERMANENT DECISION: Implanting a prosthesis is not a reversible procedure. In the classic method the corpus cavernosum is dilated serially with metal dilators; during this the tissue responsible for erection is substantially damaged and a natural, spontaneous erection is not expected afterwards. Even if the prosthesis is removed, the previous state cannot be restored.

In recent years a distinction has emerged at this point. Cavernous-sparing approaches aim to preserve the cavernosal tissue and artery as far as possible during dilation. A 2026 systematic review and meta-analysis reported that, in patients operated on with a tissue-sparing technique, preservation of the cavernosal artery and post-operative partial tumescence (residual tumescence) were markedly more frequent than with classic serial dilation, while complication rates were statistically similar between the two techniques. This evidence rests on 4 randomised studies and a total of 193 patients; it is therefore promising, but the number of patients is still limited.

This finding does NOT mean that you will have an erection sufficient for intercourse without the device after a prosthesis is implanted. What is preserved is partial tumescence and vascular function; rigidity is still provided by the prosthesis. The decision remains permanent. For this reason a penile prosthesis is recommended only after the other treatment options have genuinely been tried and expectations have been discussed in detail.

There are two basic implant types. In the three-piece inflatable prosthesis the cylinders are accompanied by a small pump placed in the scrotum and a fluid reservoir placed in the abdomen; squeezing the pump produces rigidity, and afterwards the fluid returns so the penis becomes soft again. In the malleable implant the penis stays semi-rigid at all times and is positioned by hand.

The guidelines of the European Association of Urology state that, in appropriately selected patients, penile prosthesis surgery is a treatment with high reported patient and partner satisfaction. The strongest determinant of that satisfaction is having discussed expectations properly before surgery.

AQUADISSECTION (FLUID-ASSISTED DISSECTION): This is one way of applying the tissue-sparing approach described above. Instead of forcing the inside of the corpus cavernosum mechanically with metal dilators, the tissue planes are separated by delivering fluid under pressure. The aim is to reduce the mechanical stress placed on the cavernosal tissue, the tunica and the urethra during dilation. In our clinic this technique is used in selected cases found suitable after assessment; it is not applied routinely in every patient.

Aquadissection can be particularly meaningful where the corporal tissue has become firm and narrowed (fibrotic): after prolonged priapism, after a previously implanted prosthesis has been removed because of infection, or in advanced Peyronie’s disease. In such cases mechanical dilation is technically difficult and the risk of injury increases.