Abstract
A penile prosthesis/implant is an excellent option for men with erectile dysfunction refractory to medical treatment or with contraindications to medical management. In this narrative review, we discuss the different types of penile prostheses and the considerations for patient and device selection to maximize satisfaction. There are three main prosthesis types to choose from: three-piece inflatable devices, two-piece inflatable devices, and malleable/semirigid devices. The three-piece devices are the gold standard in advanced economy countries but require reservoir placement and manual dexterity, which can be limiting to some patients. The two-piece inflatable devices are a good option for patients who have standard-sized penises, lack significant penile pathology, have limited dexterity issues, or should avoid reservoir placement due to potential complications. The malleable devices are popular in countries where insurance coverage is limited but are increasingly used in advanced economy countries for length conservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for patient–partner satisfaction. Surgeons need to be familiar with the strengths and limitations of each device and the patient characteristics that will yield the best outcome from penile prosthesis surgery.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120:151–7.
Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016;13:489–518.
Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, et al. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol. 2022;19:534–46.
Akakpo W, Pineda MA, Burnett AL. Critical analysis of satisfaction assessment after penile prosthesis surgery. Sex Med Rev. 2017;5:244–51.
Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis: results of a 2 center study. J Urol. 2001;166:932–7.
Bertero EB, Antunes DL. Surgical treatment of erectile dysfunction. Sex Med Rev. 2015;3:316–27.
Khera M, Mulcahy J, Wen L, Wilson SK. Is there still a place for malleable penile implants in the United States? Wilson’s Workshop #18. Int J Impot Res. 2023;35:82–9.
Lee DJ, Najari BB, Davison WL, Al Awamlh BAH, Zhao F, Paduch DA, et al. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. J Sex Med. 2015;12:1638–45.
Infla10® X Inflatable Penile Prosthesis | Great Erection & Natural Flaccidity. Rigicon. https://www.rigicon.com/inflatable-penile-prosthesis/. Accessed September 20, 2022.
Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017;6:375–45.
Mulcahy JJ, Austoni E, Barada JH, Choi HK, Hellstrom WJG, Krishnamurti S, et al. The penile implant for erectile dysfunction. J Sex Med. 2004;1:98–109.
Abdelsayed GA, Levine LA. Ambicor 2-piece inflatable penile prosthesis: who and how? J Sex Med. 2018;15:410–5.
Akula KP, Raheem OA. Fundamentals of prosthetic urology. Asian J Androl. 2019;22:20–7.
Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol. 2012;2012:707321.
Masterson JM, Kava B, Ramasamy R. Commercial insurance coverage for inflatable penile prosthesis at a tertiary care center. Urol Pract. 2019;6:155–8.
Barnard JT, Grimaud L, Yafi FA. Does Medicaid cover penile prosthesis surgery? A state-by-state analysis. J Sex Med. 2021;18:1455–60.
Wilson SK, Cleves MA, Delk JR. Ultrex cylinders: problems with uncontrolled lengthening (the S-shaped deformity). J Urol. 1996;155:135–7.
Raheem OA, Hsieh TC. Penile prosthetic surgery for the management of Peyronie’s disease. Transl Androl Urol. 2017;6:S815–21.
Rodriguez KM, Kohn TP, Davis AB, Hakky TS. Penile implants: a look into the future. Transl Androl Urol. 2017;6:S860–6.
Masterson TA, Palmer J, Dubin J, Ramasamy R. Medical pre-operative considerations for patients undergoing penile implantation. Transl Androl Urol. 2017;6:S824–9.
AMS 700TM Inflatable Penile Prosthesis | Risks. https://www.bostonscientific.com/en-US/products/penile-prosthesis/ams-700-inflatable-penile-prosthesis/risks.html. Accessed September 20, 2022.
MH-451709-AB-ams700-designed-for-confidence.pdf. https://www.bostonscientific.com/content/dam/bostonscientific/uro-mh/resources/erectile-dysfunction/ams-700/MH-451709-AB-ams700-designed-for-confidence.pdf. Accessed October 24, 2022.
Simon DP, Alter K, Bajic P, Levine LA. Device profile of the Ambicor two-piece inflatable penile prosthesis for treatment of erectile dysfunction: overview of its safety and efficacy. Expert Rev Med Devices. 2021;18:9–14.
Using AMS Ambicor Penile Impant. https://www.bostonscientific.com/en-US/patients-caregivers/device-support/penile-implants/ambicor.html. Accessed February 3, 2023.
Murphy AM, O’Leary M. Failure of the Ambicor® inflatable penile prosthesis to deflate. Int J Impot Res. 2005;17:291–2.
Welliver RC, Fonseca AN, West BL, McVary KT, Köhler TS. Autoinflation leading to failure of two-piece ambicor implantable penile prosthesis: an outcome from a methodical treatment of recalcitrant stuttering priapism. Case Rep Urol. 2014;2014:e529037.
Gentile G, Franceschelli A, Massenio P, Tuccio A, Cocci A, Divenuto L, et al. Patient’s satisfaction after 2-piece inflatable penile prosthesis implantation: an Italian multicentric study. Arch Ital Urol Androl. 2016;88:1–3.
Wang VM, Levine LA. Safety and efficacy of inflatable penile prostheses for the treatment of erectile dysfunction: evidence to date. Med Devices (Auckl). 2022;15:27–36.
Hoebeke PB, Decaestecker K, Beysens M, Opdenakker Y, Lumen N, Monstrey SM. Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57:334–41.
Preto M, Blecher G, Timpano M, Gontero P, Falcone M. The frontier of penile implants in phalloplasty: is the ZSI 475 FTM what we have been waiting for? Int J Impot Res. 2021;33:779–83.
Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int. 2006;97:129–33.
Casabé AR, Sarotto N, Gutierrez C, Bechara AJ. Satisfaction assessment with malleable prosthetic implant of Spectra (AMS) and Genesis (Coloplast) models. Int J Impot Res. 2016;28:228–33.
Habous M, Tealab A, Farag M, Soliman T, Williamson B, Mahmoud S, et al. Malleable penile implant is an effective therapeutic option in men with Peyronie’s disease and erectile dysfunction. Sex Med. 2018;6:24–9.
Montorsi F, Guazzoni G, Bergamaschi F, Rigatti P. Patient-partner satisfaction with semirigid penile prostheses for Peyronie’s disease: a 5-year followup study. J Urol. 1993;150:1819–21.
Gross MS, Phillips EA, Balen A, Eid JF, Yang C, Simon R, et al. The malleable implant salvage technique: infection outcomes after mulcahy salvage procedure and replacement of infected inflatable penile prosthesis with malleable prosthesis. J Urol. 2016;195:694–8.
Köhler TS, Modder JK, Dupree JM, Bush NC, McVary KT. Malleable implant substitution for the management of penile prosthesis pump erosion: a pilot study. J Sex Med. 2009;6:1474–8.
Moskovic DJ, Gittens P, Avila D Jr., Chandrashekar A, Khera M, Lipshultz LI. Favorable female sexual function is associated with patient satisfaction after inflatable penile prosthesis implantation. J Sex Med. 2011;8:1996–2001.
Vakalopoulos I, Kampantais S, Ioannidis S, Laskaridis L, Dimopoulos P, Toutziaris C, et al. High patient satisfaction after inflatable penile prostheses implantation correlates with female partner satisfaction. J Sex Med. 2013;10:2774–81.
Wallen K, Lloyd EA. Female sexual arousal: genital anatomy and orgasm in intercourse. Horm Behav. 2011;59:780–92.
Herbenick D, Fu TCJ, Arter J, Sanders SA, Dodge B. Women’s experiences with genital touching, sexual pleasure, and orgasm: results from a U.S. probability sample of women ages 18 to 94. J Sex Marital Ther. 2018;44:201–12.
International Society for Sexual Medicine. Sexual Health Q&A. What is outercourse? https://www.issm.info/sexual-health-qa/what-is-outercourse. Accessed September 20, 2022.
Author information
Authors and Affiliations
Contributions
Both authors met all the following criteria: conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results; drafted or revised the manuscript; approved the final version; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Goodstein, T., Jenkins, L.C. A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient. Int J Impot Res 35, 623–628 (2023). https://doi.org/10.1038/s41443-023-00765-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-023-00765-7
This article is cited by
-
Perioperative outcomes of penile prosthesis implantation in Germany: results from the GRAND study
International Journal of Impotence Research (2023)