What Is a Penile Implant?

Erectile Dysfunction and Permanent Treatment

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Large-scale epidemiological studies show that it affects 52% of men aged 40–70.

In patients who do not respond to first-line treatments (lifestyle changes, PDE5 inhibitors) or second-line treatments (intracavernosal injection), penile implant implantation is recommended as third-line treatment.

Penile implant implantation, recommended as the last-line treatment option in guidelines by EAU (European Association of Urology) and AUA (American Urological Association), is recognized as the most effective and permanent solution for treatment-resistant ED.

When comparing patient satisfaction rates, significant differences are evident:

%51.6

Medication
(PDE5i)

%40.9

Injection
Therapy

%80-95

Penile
Implant

Op. Dr. Niyazi Umut Özdemir: “I see a significant amount of misinformation about this topic in society. Some patients think of a penile implant as a frightening ‘last resort’ procedure, while others believe life will be completely transformed after surgery. The truth, however, lies between these two extremes. When the right patient is selected and the procedure is performed with the correct technique and well-managed process, penile implant surgery can be an extremely satisfying treatment option.”

Op. Dr. Niyazi Umut Özdemir - Üroloji Uzmanı

%52 ED in men aged 40-70

11 Do orgasm and ejaculation continue after surgery?

A penile implant restores the erection mechanism; ejaculation and orgasm functions are largely preserved. If the patient's orgasm capacity was intact before surgery, orgasm can usually be achieved after surgery as well. However, in patients who have previously undergone prostate surgery, have neurological disease, or have other sexual function disorders, these topics should be evaluated separately.

12 Does a penile implant increase sexual desire?

No, a penile implant is not a treatment that increases sexual desire (libido). Libido is related to other factors such as hormonal status, mood, relationship dynamics and general health. The implant primarily restores erectile function. However, regaining sexual function may help some couples improve their relationship and boost confidence.

13 Is there an age limit for this surgery?

There is no upper age limit for a penile implant. Patients whose health allows them to tolerate general or spinal anesthesia can benefit from this surgery even over the age of 80. It is not age but general health status and expectations that are determining factors. Likewise, in younger patients with serious diabetes, neurological disease, or permanent post-surgical erectile dysfunction, a implant may also be considered.

14 Is my surgery safe in terms of confidentiality?

Like any urology appointment, this surgery is handled within the framework of patient privacy. Patient information is kept confidential in accordance with medical ethics and legal regulations. The surgery and treatment process are conducted with complete confidentiality.

15 Should the partner be involved in the process?

Post-operative satisfaction is closely related not only to technical success but also to proper pre-operative information. Involving the partner in the process can facilitate post-operative adaptation. In couples where sexuality has stagnated due to long-standing erectile dysfunction, sexual therapy or couples counseling support can also be considered when needed.

Risk Factors

Causes of Erectile Dysfunction

The main organic and surgical causes of erectile dysfunction are summarized below.

Diabetes Mellitus (DM)

Due to vascular and neurological damage, it is among the most common organic causes of ED.

Hypertension

Arterial stiffness and impaired blood flow adversely affect erectile function.

Cardiovascular Disease

Atherosclerosis-related insufficient penile blood flow causes ED.

Radical Prostatectomy

Erectile dysfunction developing due to nerve damage following prostate cancer surgery.

Peyronie's Disease

ED accompanied by penile curvature and painful erections.

Pelvic Surgery / Radiotherapy

ED following bladder, rectal and other pelvic organ surgeries or radiotherapy.

Neurological Diseases

Multiple sclerosis (MS), spinal cord injury and other neurological conditions.

Medication-Resistant ED

Persistent erectile insufficiency despite PDE5 inhibitors and intracavernosal injection treatments.

Patient Selection

Who Is a Candidate for Penile Implant, and Who Is Not?

Suitable Candidates

✓ Patients who do not respond to medication (PDE5 inhibitors) — especially those with long-standing diabetes
✓ Patients who cannot continue or are unsatisfied with conservative methods such as injections or vacuum devices
✓ Patients with advanced erectile dysfunction developing after prostate cancer surgery
✓ Cases with serious erectile dysfunction combined with Peyronie's disease
✓ Individuals with impaired erectile function due to spinal cord injury or neurological disease
✓ Patients who cannot use oral ED medications due to cardiac medications

Situations Requiring Careful Evaluation

⚠ Patients with active infection
⚠ Patients with uncontrolled diabetes
⚠ Individuals with serious psychiatric non-compliance
⚠ Those with manual dexterity problems that would prevent post-operative device use
⚠ Individuals with unrealistic expectations (e.g., expecting the penis to be much larger than before)
⚠ Patients whose general condition is not suitable for anesthesia and surgery

Important: The primary purpose of a penile implant is not cosmetic enlargement, but to restore function. Expectations must be discussed during the pre-operative consultation.

Treatment Options

Types of Penile Prostheses

The most appropriate implant type for each patient is determined by a specialist urologist based on manual dexterity, general health status and expectations.

Malleable Implant

Malleable / Semi-Rigid

Always maintains a certain firmness; bent upward for use and downward for concealment. Its simple and reliable mechanical design is a key feature.

✓ Advantages

✓ Lower cost

✓ Easy to use and maintain

✓ Very low risk of mechanical failure

⚠ Disadvantages

✗ Does not provide a natural appearance

✗ Penis is permanently semi-rigid

Two-Piece Inflatable Implant

e.g.: AMS Ambicor

Consists of a cylinder + scrotal pump combination. Provides a more natural appearance during use while maintaining mechanical simplicity.

✓ Advantages

✓ More natural appearance than malleable implant

✓ Relatively easy to use

⚠ Disadvantages

✗ Less rigidity compared to the 3-piece implant

✗ Limited inflation capacity

⭐ Gold Standard

Three-Piece Inflatable Implant

AMS 700 · Coloplast Titan

The most advanced system consisting of a cylinder + scrotal pump + abdominal reservoir. Provides the most natural erection-flaccidity cycle.

✓ Advantages

✓ Most natural erection and flaccidity

✓ Highest patient and partner satisfaction (85-97%)

✓ Long-term durability (15-20 years)

✓ Antibiotic-coated models available

⚠ Considerations

! Requires a learning period for pump operation

! More extensive surgical procedure

Step-by-Step Process

Surgical Process

The surgical process planned with an experienced urologist consists of six key steps, from comprehensive evaluation to full recovery.

Pre-Surgical Evaluation

Detailed physical examination, penile Doppler ultrasound, and hormonal and biochemical laboratory tests are performed to evaluate the patient's general health status. Implant selection is made.

Surgical Preparation

Pre-operative antibiotic prophylaxis is administered. Meticulous sterilization protocols are implemented. General or spinal anesthesia method is determined.

Surgical Procedure

An approximately 10 cm incision is made via a penoscrotal or infrapubic approach. The corpus cavernosum is dilated and implant cylinders are placed. Pump and reservoir implantation is completed.

Post-Operative Follow-up

A Foley catheter is placed and an elastic bandage is applied. The patient is observed in hospital for an average of 1-2 days. The first follow-up appointment is scheduled.

Recovery Period

Sexual activity is recommended to be avoided for 4-6 weeks. Implant training is provided on day 45; correct use of the pump is taught. Regular check-ups are maintained.

Return to Normal Life

Sexual activity can be resumed from week 6. Patients who use the implant correctly achieve a complete, natural quality of sexual life.

Sterile Operating Environment

Implantation surgery performed to the highest hygiene standards

Clinical Assessment

Advantages & Limitations

All advantages and considerations to support informed decision-making.

Advantages

✓ Permanent solution — no medication dependency

✓ Highest patient satisfaction rate (80-95%)

✓ Natural erection feeling (3-piece)

✓ High partner satisfaction (76-96%)

✓ No restriction on duration of intercourse

✓ 15-20 years durability

✓ Applicable in diabetes and cardiovascular disease

✓ Can be combined with curvature correction in Peyronie's disease

Considerations

⚠ Irreversible surgical procedure

⚠ Infection risk (1-5%)

⚠ Mechanical failure probability (5-15% / 10 years)

⚠ May cause a slight sensation of penile shortening

⚠ Eliminates natural erection capacity

⚠ Revision surgery may be required

⚠ Requires a learning period for pump operation

Psychological Adjustment

Pre-Operative Expectation Management and Psychological Adjustment

Proper expectation management and psychological adjustment are just as critical as technical expertise for a successful outcome.

Realistic Expectations

• A penile implant is not an enlargement surgery
• The goal is to provide functional rigidity within existing anatomical limits
• If sexual desire is low, or there are orgasm problems or serious ejaculation disorders, these should be evaluated separately
• The greatest cause of dissatisfaction: having different expectations in mind after a technically successful surgery

Psychological Adjustment Process

• Getting familiar with the new system may take time (1–3 months)
• Returning to sexual life is an emotional process for men who have long experienced erectile problems
• Good information, patient follow-up and involving the partner in the process are very valuable
• Sexual therapy or couples counseling support can be considered when needed

Partner Communication

• If the patient has a regular partner, open communication before and after surgery directly contributes to the success of the process
• Partners often report that they do not notice the inflatable implant
• Partner satisfaction is reported in the literature to be between 76–96%
• In some couples, the relationship dynamic may change positively after the implant

Frequently Asked Questions

Common Questions

Answers to the most frequently asked questions about penile implant surgery.

1 Does penile implant surgery hurt?

The surgery is performed under general or spinal anesthesia; patients feel no pain during the procedure. Post-operative pain and discomfort are effectively controlled with analgesics and typically diminish significantly within a few days.

2 When can I have sexual intercourse after surgery?

Implant training is typically provided 4-6 weeks after surgery and sexual activity can then begin. Full adherence to the recovery period is extremely important for both short- and long-term success.

3 Can the implant be noticed from the outside?

Three-piece inflatable prostheses offer a very natural appearance when deflated. It is nearly impossible for them to be noticed under clothing or in daily life.

4 What is the lifespan of the implant?

The average expected lifespan of modern penile prostheses is 15-20 years. Clinical studies report a 10-year implant survival rate of 77.6% for the AMS 700 series.

5 What is the infection risk after surgery?

Thanks to antibiotic-coated modern prostheses and meticulous surgical technique, the infection rate remains at 1-5%. This rate decreases further when working with experienced surgeons.

6 If medication treatment fails, is a implant the only option?

In patients who do not respond to PDE5 inhibitors (oral medications) and intracavernosal injection treatments, penile implant implantation is recommended in clinical guidelines as the most effective and permanent treatment option.

7 Can implant surgery be performed in diabetic patients?

Yes, diabetes is one of the most common organic causes of ED. Surgery can be safely performed once blood sugar control is achieved at a sufficient level. Diabetic patients achieve very successful results with appropriate preparation.

8 How long does the surgery take?

Surgery performed by an experienced surgeon is generally completed within 45-90 minutes. The average hospital stay is 1-2 days; most patients are discharged in a short time.

9 Does penis size change after implant implantation?

The implant preserves the existing penis size; however, some patients may feel a slight shortness in the initial period. This sensation resolves over time with regular use and tissue accommodation.

10 Which type of implant is most suitable for me?

The three-piece inflatable implant is accepted as the gold standard in international guidelines. However, the most suitable implant type is jointly determined by a urologist after evaluating the patient's manual dexterity, general health status, anatomical features and personal expectations. You can contact our clinic for a comprehensive consultation.

Academic References

1. Henry GD, Bernal RM. Contemporary Patient Satisfaction Rates for Three-Piece Inflatable Penile Prostheses. Advances in Urology. 2012. DOI: 10.1155/2012/707321

2. Vitarelli A et al. Long-term satisfaction with AMS 700 CX/CXR: 87.7% satisfaction, 77.6% implant survival at 10 years. PMC7719505. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719505/

3. Antonini G et al. Minimally invasive infrapubic inflatable penile implant implant. Int J Impot Res. 2016;28(1):4-8. DOI: 10.1038/ijir.2015.33

4. Çayan S et al. Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: 883 patients. J Sex Med. 2019. DOI: 10.1016/S1569-9056(19)30339-2

5. Ozan T et al. Two-piece inflatable penile implant surgery clinical outcomes. Firat Medical Journal. 2018;32(1):27-30.

6. Michigan Medicine. The truth about penile implants. 2024. https://www.michiganmedicine.org/health-lab/truth-about-penile-implants

7. Patients' satisfaction rate after penile implant surgery. Scientific Reports. 2025. PMC12491504

8. Advances in penile prosthetics: current trends and future directions. Nature. 2024. DOI: 10.1038/s41443-024-01010-5

Treatment of Erectile Dysfunction
with Penile Implant
Surgery

Erectile Dysfunction and Permanent Treatment

11 Do orgasm and ejaculation continue after surgery?

12 Does a penile implant increase sexual desire?

13 Is there an age limit for this surgery?

14 Is my surgery safe in terms of confidentiality?

15 Should the partner be involved in the process?

Causes of Erectile Dysfunction

Who Is a Candidate for Penile Implant, and Who Is Not?

Suitable Candidates

Situations Requiring Careful Evaluation

Types of Penile Prostheses

Surgical Process

Sterile Operating Environment

Success Rates

Advantages & Limitations

Pre-Operative Expectation Management and Psychological Adjustment

Realistic Expectations

Psychological Adjustment Process

Partner Communication

Common Questions

1 Does penile implant surgery hurt?

2 When can I have sexual intercourse after surgery?

3 Can the implant be noticed from the outside?

4 What is the lifespan of the implant?

5 What is the infection risk after surgery?

6 If medication treatment fails, is a implant the only option?

7 Can implant surgery be performed in diabetic patients?

8 How long does the surgery take?

9 Does penis size change after implant implantation?

10 Which type of implant is most suitable for me?

Doctor & Clinic

Contact Us for an Expert Consultation

Treatment of Erectile Dysfunction with Penile Implant Surgery

Erectile Dysfunction and Permanent Treatment

11 Do orgasm and ejaculation continue after surgery?

12 Does a penile implant increase sexual desire?

13 Is there an age limit for this surgery?

14 Is my surgery safe in terms of confidentiality?

15 Should the partner be involved in the process?

Causes of Erectile Dysfunction

Who Is a Candidate for Penile Implant, and Who Is Not?

Suitable Candidates

Situations Requiring Careful Evaluation

Types of Penile Prostheses

Surgical Process

Sterile Operating Environment

Success Rates

Advantages & Limitations

Pre-Operative Expectation Management and Psychological Adjustment

Realistic Expectations

Psychological Adjustment Process

Partner Communication

Common Questions

1 Does penile implant surgery hurt?

2 When can I have sexual intercourse after surgery?

3 Can the implant be noticed from the outside?

4 What is the lifespan of the implant?

5 What is the infection risk after surgery?

6 If medication treatment fails, is a implant the only option?

7 Can implant surgery be performed in diabetic patients?

8 How long does the surgery take?

9 Does penis size change after implant implantation?

10 Which type of implant is most suitable for me?

Doctor & Clinic

Contact Us for an Expert Consultation

Treatment of Erectile Dysfunction
with Penile Implant
Surgery