Inflatable Three-Piece Penile Prosthesis

The three-piece inflatable penile prosthesis is the most commonly selected implant for men seeking a natural-appearing and highly controllable erection. Two inflatable cylinders are placed inside the erectile chambers of the penis, a fluid reservoir is placed in the pelvis or behind the abdominal wall muscles, and a small pump is positioned in the scrotum between the testicles.

When the patient wants an erection, squeezing the scrotal pump transfers fluid into the cylinders. After sexual activity, the device is deflated using a separate release mechanism.

The device is completely concealed within the body (I like to call it “locker room proof”) and produces an erection that is firm and reliable whenever desired. Modern implants are designed for long-term durability, although mechanical failure can eventually occur and may require revision surgery. At 10 years, 80% of devices are still functioning. At 15 years, 70% of devices are still functioning. At 20 years, 50% of devices are still functioning. 

Surgery is about 40-60 minutes. Most patients spend one night or no time in the hospital. Significant swelling and bruising are expected initially. Most men require approximately 4–6 weeks before full sexual activity, although the timeline varies by surgeon, patient healing, and implant type. Patients are taught how to operate the device once healing is adequate.

Important risks include infection, bleeding, pain, erosion, device malfunction, and the possibility of needing revision surgery. Penile length can also appear shorter after implantation compared with the patient's remembered natural erection, particularly in men who have had longstanding ED. This will be discussed in detail in the office during consultation, and is typically due to unrecognized shortening that has already taken place as part of the ED disease process, rather than the implant surgery itself.