Penile Prostheses in the Sildenafil Era

The first effective treatment for physical erectile difficulties occurred with the introduction of penile implants more than 25 years ago. The market share these devices hold in the treatment of erectile dysfunction (ED) has declined steadily as less aggressive treatments have been introduced. However, there remains a subset of patients who do well with implants, which includes those with penile scarring and the nonresponders to more conservative treatments. Two main categories of implants are available: the semirigid rods and the inflatable devices. The semirigid rods are inserted easily and are positionable with minimal effort. However, they give a permanently rigid penis and may be difficult to conceal during daily activities. The inflatable models are more challenging to insert but offer a more natural appearance and function to the penis. Repair rates for these devices have been reasonable, in the range of 5% to 10% in the first 5 years. Of all the treatments of EDs patient and partner satisfaction has been the highest with penile implants, in the range of 80% or more. These devices provide a predictable and reliable method, usable on demand, for restoring erectile function.