Diagnosis of erectile dysfunction (ED) is increasing due to the prevalence of cardiovascular disease, diabetes, lifestyle changes, and an aging population. The worldwide prevalence of ED in 2025 was projected to be 322 million men. ED can negatively affect a man's psychosocial health and quality of life. Of all the available treatment options for ED, the penile prosthesis offers the highest patient and partner satisfaction rates (the inflatable type more than the malleable type) and is covered by most insurance plans in the United States. Despite being irreversible and invasive, per the 2018 American Urological Association guidelines, it is valid for men to begin with a penile prosthesis as the first line of treatment. Consequently, approximately 30 000 penile prostheses are implanted annually in the United States. However, surgery carries inherent risks and potential complications, and like any other implant, an inflatable penile prosthesis (IPP) can be complicated by infection, mechanical failure, and malpositioning. Detection of these complications can be challenging at clinical examination, and MRI is the preferred modality to interrogate the IPP. Other imaging modalities such as CT and US may be used according to the suspected complication and provide complementary information. MRI permits anatomic evaluation of the IPP and offers functional assessment by allowing acquisition of images during both the inflated and deflated states. The aim of this article is to familiarize radiologists with the normal imaging appearance and complications of the three-piece IPP for accurate diagnosis and effective communication with referring clinicians. A structured reporting template is proposed to guide clinical practice. ©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Schuch and Chojniak in this issue.

To evaluate the incidence and predictive factors of early penile prosthesis (PP) infection within a contemporary regional cohort in the North of England. A retrospective review of all PP implantations was conducted at a tertiary urology and andrology centre between 2018 and 2025, with variables including age, BMI, smoking, relevant comorbidities, pre-operative HbA1C, immunosuppressant use and device-related variables. Data were analysed using SPSS v29, with univariate logistic regression performed to identify factors of early infection (≤30 days). A p-value < 0.05 was considered statistically significant. A total of 103 patients underwent PP implantations. Mean age at implant was 59.4 ± 9.9years. The comorbidity burden of diabetes, hypertension and dyslipidaemia was 35.0%, 49.5% and 39.8%, respectively, with mean pre-operative HbA1C at 45.6mmol/mol. Notably, 9.7% of patients were on chronic immunosuppressive therapy. Early prosthetic infection was identified in six patients (5.8%). On univariate analysis, there was a strong association between immunosuppressant use and infection (50.0% vs 7.2%, p = 0.02; OR 12.0, 95% CI 1.7-85.0). The variables of age, BMI, diabetes, hypertension, dyslipidaemia, HbA1C and implant type were not associated with infection. In this contemporary regional study, early PP infection was identified in 5.8% of the cohort, with chronic immunosuppressant use being the dominant predictor of infection. Other metabolic, clinical and implant factors were not predictive of infection. This demonstrates immunosuppression being a persistent biological vulnerability requiring risk stratification and targeted perioperative strategies. Larger, prospective multicentre studies are required to further validate its impact and inform evidence-based infection-prevention protocols.

Invited Commentary: Three-Piece Inflatable Penile Prosthesis: Imaging Insights Beyond the Operating Room.

The aim of this paper was to compare the intraoperative and postoperative outcomes of two similar groups of patients who underwent three-component penile prosthesis implantation under spinal versus local anaesthesia. We reviewed retrospectively the medical records of twenty consecutive patients who underwent three-component penile prosthesis implantation for erectile dysfunction under spinal anaesthesia (S-PPI) versus local anaesthesia (L-PPI) in the period between January 2023 and January 2025. As regards the assessment of the pain, the patient's requests of sedation due to pain complaining during the induction of the anesthesia and the following surgical procedure were assessed. The Visual Analogue Scale (VAS) was also used for pain assessment six hours and one day after the surgical procedure. A modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) validated questionnaire was used to evaluate patient satisfaction after the prosthesis implantation. Perioperative and postoperative complications were also assessed. There was no statistical difference in terms of age, BMI and etiology of erectile dysfunction among the two groups. As regards the assessment of the pain, a significantly higher request of sedation was assessed in the S-PPI group than in the L-PPI group of patients (10% versus 40%) due to discomfort during the local anaesthesia or the surgical procedure (p < 0.05). On the contrary, mean VAS scores of 6.0 and 6.5, 5.5 and 5 were reported by the S-PPI and L-PPI groups at 6 and 24 hours after surgery respectively, showing a similar degree of postoperative pain among the two groups of patients. The EDITS questionnaire scores showed no significant difference between the two groups in terms of patient satisfaction. As regards the complications, no significant difference was assessed between the two groups of patients. Our preliminary outcomes showed that a threecomponent penile prosthesis implantation under local anesthesia can be successfully performed in terms of postoperative pain control, acceptable complication rates and remarkable satisfaction scores with respect to the same procedure under spinal anaesthesia. Concerning the perioperative pain control, a significantly higher request of sedation was reported in the L-PPI group of patients with respect to the S-PPI group due to discomfort during the induction of local anesthesia or the implant procedure. Basing on these aspects, we think that a three-component penile prosthesis implantation in local anaesthesia could be proposed in selected patients with comorbidities which contraindicated spinal or general anesthesia or in patients unwilling to undergo these types of anesthesia after a preoperative counselling regarding the pain control and the possible need of sedation.

Comment on: Application of gelatin sponge (Gelfoam®) as a hemostatic agent in inflatable penile prosthesis implantation.

Intraoperative Irrigation in Inflatable Penile Prosthesis Surgery: Past Lessons, Current Evidence, and Future Directions.

Preoperative anxiety (PA) adversely affects surgical outcomes. Compared to other surgical procedures, penile prosthesis implantation (PPI) may result in exceptionally high PA because of concerns about a foreign implant and postoperative patient's and partner's expectations, yet PA in this population has not been previously studied. This prospective cross-sectional study included all men who underwent PPI in our institute from November 2023 to November 2025. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire was used to determine the degree of PA. Participants were stratified into low (< 11) and high (≥ 11) anxiety groups based on total anxiety scores. Among 123 participants (mean age: 56.3 years), 52.8% demonstrated clinically significant PA. On univariate analysis, higher PA was associated with education level, number of previous surgical procedures, personal history of surgical or anesthetic complications, duration of surgical consultations, internet information-seeking, discussing surgery with a friend, anesthesia type, and operative duration (P < 0.05 for all). On multivariate analysis, personal history of prior surgical or anesthetic complications and internet information-seeking remained independent predictors of high PA (P < 0.05). Common concerns included device failure (25.2%), inability to activate the device (14.6%), and perceived changes in penile length, girth, or rigidity (12.2%, 9.8%, and 11.4%, respectively). PA is highly prevalent among men undergoing PPI. Prior personal history of previous surgical or anesthetic complications and internet information-seeking independently predicted high anxiety. This data might help healthcare providers to specifically target this group of patients to decrease the level of PA and its downstream consequences.

Penile prostheses have revolutionized the treatment of erectile dysfunction in men over the past 50 years, with implant infections remaining the most serious complication. Over the last 15 years, however, infection rates have declined substantially. This improvement is attributable to technological advances in implant design, particularly infection-retardant coatings, improved perioperative prophylactic concepts, and optimized patient selection based on identified risk factors. Modern surgical strategies such as the no-touch technique, tailored antibiotic and antifungal prophylactic regimens, and antiseptic irrigation protocols during revision procedures have contributed substantially to the reduction of postoperative infections. At the same time, the management of manifest implant infections has evolved: emergency explantations are now largely reserved for severe systemic infections, whereas targeted antimicrobial therapies followed by salvage surgery are increasingly being adopted. These developments enable a sustained reduction in infection-related complications associated with penile prosthesis implantation.

Postoperative retraction is a significant limitation of traditional penile lengthening procedures that rely solely on suspensory ligament release. This retraction can lead to dissatisfaction among patients seeking enhancement. To address this issue, a novel two-step lengthening technique has been developed, which combines suspensory ligament release with an autologous dermal-fat graft and reinforcement using spermatic cord-associated fat. To evaluate the efficacy and safety of this innovative two-step lengthening technique in reducing postoperative retraction and improving overall patient outcomes in penile augmentation surgery. Between September 2024 and March 2025, thirty-one adult male patients underwent suspensory ligament release via a reversed V-shaped suprapubic incision. The resulting retropubic space was filled using an autologous dermal-fat graft harvested from the lateral abdomen, customized to the assessed cavity volume. Transposed spermatic cord-associated fat pads were anchored to the base of the corpora cavernosa to reinforce the scaffold. Patients were followed up at 3, 6, and 12 months postoperatively. Penile length (flaccid and erect), complication rates, and patient satisfaction were assessed. All wounds achieved primary closure with no major complications. Mean flaccid penile length increased from 5.23 ± 0.58cm preoperatively to 6.89 ± 0.47cm postoperatively (p < 0.001), and mean erect length increased from 7.78 ± 0.63 to 9.73 ± 0.71cm (p < 0.001). No significant length loss was observed during the 12-month follow-up. Patient satisfaction levels were notably high, with 93.3% reporting satisfied or very satisfied. This vascularized, multilayer autologous scaffold approach effectively stabilizes length gains following suspensory ligament release. It represents a promising and safe strategy to minimize postoperative retraction and enhance long-term outcomes in penile augmentation surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The evolution of inflatable penile prosthesis reservoir design and placement techniques has significantly impacted patient outcomes and surgical practices. Recent advancements in reservoir design have improved device safety, durability, and surgical adaptability, which has built on decades of innovation. Concurrently, surgical techniques have evolved to accommodate anatomical variations, reduce complications, and expand options for both traditional and ectopic reservoir placement. Novel approaches, such as high submuscular reservoir placement with counter-incision, exemplify the trend toward safer and more reproducible solutions in complex cases. By synthesizing these developments, this review aims to provide a comprehensive understanding of how patient-centered care and mastery of diverse techniques can optimize outcomes and address challenges in prosthetic urology.

Patterns of mechanical failure in the Coloplast Titan Touch inflatable penile prosthesis: a 12-year single-surgeon experience.

Selective pump replacement for inflatable penile prosthesis malfunction.

The contemporary academic landscape of penile prosthesis surgery: a bibliometric analysis.

(690) The Use of Patient Decision Aids in Penile Implant Surgery

(007) Mini-Jupette Sling for Climacturia Without Penile Prosthesis

(479) Management of Distal Extrusion of a Penile Implant by Retrocapsular Repositioning, and Polypropylene Mesh Reinforcement

(612) Improved Ejaculatory Function After Penile Prosthesis Implantation: A Comparative Evaluation of Infrapubic, Penoscrotal, and Subcoronal Techniques

(148) Irrigation With 0.05% Chlorhexidine Gluconate Associated with Hydrophilic Inflatable Penile Prosthesis Infection: A Large Multi-Institutional Cohort Study

(339) Inflatable Penile Prosthesis Insertion in Cis Male Patient Affected by Exstrophy–Epispadias

(316) Penile Prosthesis Placement &amp; Egydio Tunica Expansion Procedure for the Treatment of Severe Curvature in Peyronie’s Disease with Concomitant ED