The procedure
Penile Implant Surgery: How the Operation Actually Works
A penile prosthesis is a device placed entirely inside the body to restore the ability to have an erection. It is the established treatment for erectile dysfunction that no longer responds to tablets, injections or a vacuum device. This page describes the whole pathway — assessment, anaesthesia, the operation itself, the hospital stay and follow-up — so that nothing about the day comes as a surprise.
- Written by
- Istanbul Penile Implant Centre editorial team
- Medically reviewed by
- Prof. Dr. Bülent AlıcıMD, Professor of Urology and Andrology
- Published
- Last updated
Suitability
Who a penile implant is for
An implant is not a first-line treatment. It is considered when other options have been tried and have stopped working, or when the underlying cause makes them unlikely to work at all.
You may be a candidate if
- Erectile dysfunction that has not responded adequately to tablets, injections, vacuum devices or other non-surgical treatment.
- Erectile dysfunction after radical prostatectomy or pelvic radiotherapy.
- Erectile dysfunction related to diabetes or vascular disease where medication is insufficient.
- Peyronie’s disease with curvature and erectile dysfunction together.
- Erectile dysfunction after pelvic trauma or spinal cord injury.
- Severe scarring of the erectile tissue where blood flow can no longer be restored.
Further assessment is needed if
- Active infection anywhere in the body, which must be treated before any implant surgery.
- Poorly controlled diabetes — glycaemic control is optimised first.
- Untreated urinary tract problems or urethral stricture.
- Limited hand strength or dexterity, which affects the choice of device rather than eligibility.
- Erectile dysfunction that has not yet been investigated or treated non-surgically.
- Psychological or relationship factors that would benefit from being addressed before surgery.
Deciding on an implant is a shared decision. Because implantation permanently alters the erectile tissue, it is important to understand what it rules out as well as what it restores — this is covered in detail on our page about risks and safety.
Before surgery
Preparation and pre-operative assessment
Most of the work that determines a good outcome happens before the day of surgery. Infection prevention and glycaemic control matter more than any single technical step in theatre.
Step 1
History and examination
A urological history, a review of your medications, and an examination of the penis, scrotum and abdomen, including any scars from previous surgery.
Step 2
Confirming the diagnosis
Erectile dysfunction is confirmed and its cause assessed. Where relevant this includes blood tests such as glucose, HbA1c, testosterone and lipids.
Step 3
Reviewing previous treatment
An implant is normally considered after other treatments have been tried or are unsuitable. What you have already used, and how it worked, is part of the assessment.
Step 4
Anaesthetic assessment
A pre-anaesthetic review, with an ECG and chest imaging where indicated, to confirm you are fit for a general or spinal anaesthetic.
Step 5
Screening for infection
Urine is checked and any infection treated before surgery. Implant surgery is not performed in the presence of an active infection.
Step 6
Device selection and consent
The type of device, the expected outcome and the risks are discussed, and consent is taken. Final sizing is decided during the operation itself.
In theatre
The operation, step by step
Surgery is performed under general or spinal anaesthesia and usually takes between forty-five and ninety minutes for a straightforward first-time implant. Revision surgery and cases with scarring take longer.
Anaesthesia and preparation
Surgery is performed under general or spinal anaesthesia. The surgical field is prepared with antiseptic and intravenous antibiotics are given before the incision.
Incision
A single small incision is used. The most common approaches are at the base of the penis where it meets the scrotum, or just above the pubic bone. The choice depends on the device, your anatomy and any previous surgery.
Preparing the erectile bodies
The corpora cavernosa — the paired erectile chambers — are opened and gently dilated to create space for the cylinders. Their length is measured directly.
Placing the cylinders
The cylinders are chosen from the sizes available on the basis of those measurements and placed inside the erectile bodies. This is why device sizing is confirmed in theatre rather than beforehand.
Placing the pump and reservoir
For an inflatable device, the pump is positioned in the scrotum and the reservoir in the space behind the pubic bone or within the abdominal wall. A malleable device has neither.
Connection, testing and closure
The components are connected and the device is inflated and deflated on the table to confirm it works and that the result is straight. The incision is then closed and a dressing applied.
Which device is implanted changes the detail of these steps. A three-piece inflatable prosthesis requires a pump and a reservoir; a malleable implant requires neither. The differences are set out in our comparison of the types of penile implant.
Hospital stay
The first day and night
Almost all patients stay one night. A second night is arranged when it is clinically preferable rather than as a standard extra.
Length of stay
One night in hospital is usual. You are normally discharged the following day once you are comfortable, passing urine and walking.
Catheter
A urinary catheter is often placed during surgery and removed before or shortly after discharge. It is not always needed — it depends on the operation and on your surgeon’s practice.
Pain relief
Regular pain relief is given from the outset. Discomfort and swelling of the penis and scrotum are expected in the first days.
Antibiotics
Antibiotics are given around the time of surgery and often continued for a short course afterwards, according to your surgeon’s protocol.
Device position
An inflatable device is usually left partially inflated or in a specific position for a period after surgery to help the cylinders settle. Your surgeon will tell you what applies to your device.
Before you leave
You are shown how to care for the wound, what to watch for, which medication to take and when your review appointments are.
Afterwards
Follow-up and device activation
An implant is not used immediately. The device stays deflated while tissues heal, and is activated at a separate appointment once swelling has settled.
Wound review
The wound and the swelling are checked in the first days after surgery, before you fly home.
Device activation
The device is activated only once your surgeon judges that healing allows it — commonly several weeks after surgery, not days.
Device training
You are taught to inflate and deflate the device, and asked to practise. Most men need more than one session before it feels natural.
Return to sexual activity
Intercourse resumes only after your surgeon confirms it is safe and after you can operate the device confidently.
Long-term review
Periodic review to check the device and the surrounding tissue. Report any change in function, new pain, swelling or redness promptly rather than waiting for a scheduled appointment.
The week-by-week picture, including when you can drive, shower, fly and resume intercourse, is on the recovery timeline.
Common questions about the operation
Medical references
We do not publish complication rates, device survival figures or satisfaction percentages on this website without a citation to the study they come from. Where you see a figure quoted elsewhere without a source, treat it with caution.
Guidelines and professional bodies
- Guidelines on Sexual and Reproductive HealthEuropean Association of Urology (EAU) — European guidance covering the assessment and management of erectile dysfunction, including the place of penile prosthesis surgery.
- Erectile Dysfunction: AUA GuidelineAmerican Urological Association (AUA) — United States guidance on the evaluation and treatment of erectile dysfunction, including surgical options.
- Sexual Medicine Society of North America (SMSNA)SMSNA — Professional society resources on sexual medicine, including prosthetic surgery.
- International Society for Sexual Medicine (ISSM)ISSM — International professional society with patient-facing information on sexual medicine.
- PubMedUS National Library of Medicine — Index of peer-reviewed literature. Use it to look up the primary research behind any claim you read about penile implants, including ours.
Device manufacturer documentation
- Coloplast Titan product and technical informationColoplast — Manufacturer documentation for the Titan inflatable penile prosthesis, including materials, configurations and instructions for use.
- AMS 700 product and technical informationBoston Scientific — Manufacturer documentation for the AMS 700 inflatable penile prosthesis, including models, the Conceal reservoir and InhibiZone.
Citations to be supplied
- [MEDICAL REFERENCE — long-term device survival study][JOURNAL, YEAR] — Cite a peer-reviewed source before publishing any statement about how long a device lasts.
- [MEDICAL REFERENCE — infection rate study][JOURNAL, YEAR] — Cite a peer-reviewed source before publishing any infection-rate figure.
- [MEDICAL REFERENCE — patient satisfaction study][JOURNAL, YEAR] — Cite a peer-reviewed source before publishing any satisfaction figure.
External links open in a new tab and are provided for reference only. We are not affiliated with, and do not speak for, the organisations listed.
Ask whether a penile implant is right for you
Send your medical history and Prof. Dr. Alıcı will review it personally. You will receive an honest assessment of whether an implant is appropriate, which device would be considered, and an itemised written quotation. There is no charge and no obligation.