The Impact of Penile Prosthesis Type on Early Postoperative Pain: A Prospective Comparative Study

Background/Objectives: Postoperative pain is an important determinant of early recovery and patient experience after penile prosthesis implantation. Although malleable, two-piece inflatable, and three-piece inflatable penile prostheses differ substantially in their mechanical characteristics, data comparing postoperative pain profiles among these devices remain limited. This study aimed to evaluate early postoperative pain perception following penile prosthesis implantation and compare pain outcomes according to prosthesis type. Methods: In this prospective observational study, 166 patients who underwent penile prosthesis implantation between January 2020 and December 2025 were evaluated. Patients were divided into three groups according to prosthesis type: malleable penile prosthesis (MPP; n = 35), two-piece inflatable penile prosthesis (2IPP; n = 72), and three-piece inflatable penile prosthesis (3IPP; n = 59). Postoperative pain was assessed using the visual analog scale (VAS) on postoperative day (POD) 1, 7, and 30. Total postoperative non-steroidal anti-inflammatory drug (NSAID) consumption was expressed as ibuprofen-standardized dose (mg). Multivariable linear regression analyses were performed to identify independent predictors of postoperative pain. Results: VAS scores on POD1 were comparable among the three groups (p = 0.61). However, significant differences emerged during follow-up. On POD7, both the MPP and 2IPP groups demonstrated significantly higher pain scores compared with the 3IPP group (p = 0.018 and p = 0.041, respectively). On POD30, pain scores remained significantly higher only in the MPP group, whereas no significant difference was observed between the 2IPP and 3IPP groups. Total postoperative NSAID consumption was highest in the MPP group and lowest in the 3IPP group (p < 0.001). In multivariable analysis, both MPP implantation (β = 0.95, 95% CI: 0.48-1.42; p < 0.001) and 2IPP implantation (β = 0.73, 95% CI: 0.24-1.22; p = 0.004) were independently associated with higher POD7 pain scores. For POD30, only MPP implantation remained an independent predictor of increased pain (β = 1.12, 95% CI: 0.58 -1.66; p < 0.001). Conclusions: Prosthesis type was associated with different postoperative pain trajectories after penile prosthesis implantation. While early postoperative pain appears similar across devices, malleable prostheses are associated with more persistent pain and greater analgesic requirements. Among the evaluated devices, three-piece inflatable prostheses were associated with the most favorable postoperative pain profile. These findings suggest that postoperative patient comfort should be considered alongside functional and technical factors when selecting a penile prosthesis.