Inflatable and semi-rigid implants — understanding the procedure
What is a penile prosthesis?
A penile prosthesis (or penile implant) is a medical device surgically implanted inside the penis, within the corpora cavernosa, to allow a rigidity sufficient for penetration. It is offered in cases of severe, long-standing erectile dysfunction, when medication, intracavernosal injections, or vacuum devices have not given satisfactory results.
There are two main families of implants: semi-rigid (also called malleable) prostheses and inflatable prostheses.
The two types of prostheses
The semi-rigid (malleable) prosthesis
It consists of two flexible but bendable rods inserted into the corpora cavernosa. The penis remains permanently somewhat rigid and can be manually positioned upward for intercourse, or downward the rest of the time for discretion.
- Advantages: simple mechanism, high reliability, no complex manipulation, shorter procedure.
- Drawbacks: permanent rigidity, which may be more noticeable under clothing; a less “natural” feel.
The inflatable prosthesis
It more closely mimics the natural erection mechanism through inflatable cylinders placed in the corpora cavernosa, connected to a pump implanted in the scrotum, which is itself connected to a fluid reservoir placed in the abdomen.
The 3-piece model includes:
cylinders, a scrotal pump, and a separate abdominal reservoir — this is the model offering the most natural-looking result.
Before intercourse, the man repeatedly presses the pump to transfer fluid to the cylinders and achieve rigidity. After intercourse, a release valve allows the penis to return to a flaccid state.
Comparison table
| Feature | Semi-rigid (malleable) implant | Inflatable implant (2- or 3-piece) |
|---|---|---|
| Principle | Two flexible but bendable rods implanted in the corpora cavernosa | Inflatable cylinders connected to a pump and a fluid reservoir |
| How it works | The penis is manually positioned upward for intercourse, downward otherwise | A scrotal pump inflates the cylinders before intercourse and deflates them afterward |
| Appearance / discretion | Permanent rigidity; may be more noticeable under clothing | Closer to a natural erection in appearance; flaccid at rest |
| Surgical complexity | Simpler, shorter procedure | Longer procedure, more sophisticated hardware |
| Ease of use | Simple, no mechanical manipulation required | Requires learning to operate the pump |
| Best suited for | Patients with reduced manual dexterity or a preference for simplicity | Patients seeking the most natural-looking result |
Who is this procedure considered for?
Placement of a penile prosthesis is generally offered after first- and second-line treatments have failed or are contraindicated, particularly in the following situations:
- Severe, permanent organic erectile dysfunction (diabetes, after pelvic surgery — notably prostatectomy for cancer — vascular disease, trauma, etc.)
- Failure of or intolerance to oral treatments, intracavernosal injections, or vacuum erection devices
- Peyronie’s disease associated with erectile dysfunction
- Fibrosis of the corpora cavernosa (for example, after priapism)
The choice between a semi-rigid and an inflatable device depends on age, manual dexterity, surgical history, and patient expectations, as well as the surgeon’s advice.caux, des attentes du patient, ainsi que de l’avis du chirurgien.
Prosthetic Placement in Practice
How is the procedure performed?
- General or regional anesthesia (spinal block), decided together with the anesthesiologist.
- An incision is most often made at the base of the penis (penoscrotal approach) or above the pubic bone.
- The corpora cavernosa are dilated, then the cylinders (and, for the 3-piece model, the pump and reservoir) are placed and connected.
- The procedure generally lasts between 45 minutes and 1 hour 30 minutes, depending on the type of prosthesis and the complexity of the case.
- Antibiotic prophylaxis is given to reduce the risk of infection.
- Hospital stay is usually 1 to 2 days.
Recovery after surgery immediately after the procedure
- Local pain and swelling, managed with pain relief medication.
- A compression dressing may be left in place for a few days.
- A urinary catheter may be temporarily inserted.
Convalescence
- Return to normal (non-physical) activity generally within 1 to 2 weeks.
- Strenuous physical activity and sexual intercourse should be avoided for 6 weeks to allow healing.
- A follow-up appointment is scheduled to check healing and learn how to operate the prosthesis (particularly for the inflatable model).
- Resumption of intercourse should be gradual and with the surgeon’s approval.
Possible risks and complications
As with any surgical procedure, placement of a penile prosthesis carries risks, which should be discussed in detail with the surgeon:
- Infection of the device, the most feared complication, potentially requiring removal of the prosthesis (estimated risk of around 1 to 3%, depending on the case series and context).
- Skin or mucosal erosion, persistent pain, hematoma.
- Mechanical malfunction of the device (leak, pump failure), potentially requiring further surgery at a later stage.
- Changes in sensitivity of the glans or perceived shortening of the penis.
- Initial difficulty with manipulation, particularly with inflatable prostheses.
It is important to note that placement of a penile prosthesis generally makes other erectile dysfunction treatments irreversible, since the corpora cavernosa are permanently altered.és).
Expected results
High satisfaction rates among well-informed, well-selected patients — generally above 80% in the medical literature.
The prosthesis provides sufficient rigidity for penetration, but does not restore ejaculation or orgasm sensations, which depend on other physiological mechanisms that remain intact.
The average lifespan of the device is estimated at 10 to 15 years, with the risk of mechanical failure increasing over time.
Questions to ask your surgeon
- Which type of prosthesis (semi-rigid or inflatable, 2- or 3-piece) is most suitable for my situation, and why?
- What are the specific risks related to my medical history?
- How long before I can resume sexual intercourse?
- What happens if the device fails or becomes infected?
- What is the cost of the procedure, and how is it covered by health insurance?