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Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int 2006;97:129-133.

This is a retrospective case-notes study from a well-recognized tertiary referral centre from the UK, involving a large series of 504 penile prosthesis in 447 men (mean age 52, range 21-78) over a 25 yr. period upto 2000. The majority of prostheses were malleable (393) while the remainder were 3-piece inflatable (81) and self-contained hydraulic (30). 404 men had primary implants and 43 had revision surgery. The mean follow-up was 50 (range 1-297) months. 22 patients were lost to follow-up.

The infection rate in this series was 8% while the erosion rate was 5%(commoner in diabetics,10% and after pelvic trauma with a uretheral injury,21%) .4% mechanical failure and 5% revision surgery rate was noted. Overall 89% of men were able to have sexual intercourse and overall 81% were satisfied with the results of the surgery, this being higher in men who had the inflatable variety implanted.

Implantation of a penile prosthesis remains the 'gold standard' for irreversible ED of organic causes. Three-piece inflatable prostheses can provide a paraphysiological erection and are easier to conceal, but malleable prostheses are a viable therapeutic alternative. Three-piece inflatable prostheses are more expensive and have a higher risk of device infection and mechanical failure. Malleable prostheses are cheaper and have a lower rate of removal (with a low infection rate and less mechanical failure) but higher rates of patient dissatisfaction with the prosthesis in situ. The choice for the patient is not straightforward.