Update on penile prosthesis

The aim of this narrative review is to provide a comprehensive overview of penile prostheses (PPs) for the treatment of erectile dysfunction (ED), exploring their historical evolution, types, key advancements, clinical outcomes, and future directions. A comprehensive literature search of studies published in English was conducted between January 2000 and April 2024, using databases including PubMed, MEDLINE, Embase, and the Cochrane Library. Search terms included "penile prosthesis", "penile implants", "malleable penile implant", "inflatable penile prosthesis", "two-piece IPP", "three-piece IPP", and "penile implant advancements". The included studies focused on the development, effectiveness, and complications of penile prostheses. These studies are clinical trials, randomized controlled trials, observational studies, systematic reviews, and meta-analyses. Data were synthesized qualitatively and quantitatively. Penile prostheses have significantly evolved since their invention, with notable advancements in both malleable and inflatable models. Malleable prostheses, known for their simplicity and reliability, offer a semirigid state that is beneficial for patients with limited hand dexterity or those undergoing salvage procedures. Inflatable penile prostheses (IPPs), particularly the three-piece models, have seen substantial technological improvements, including enhanced mechanical reliability, reduced infection rates due to antibiotic coatings, and better patient satisfaction. Key innovations include the development of hydrophilic coatings, parylene microcoatings, and antibiotic-impregnated implants, which have collectively reduced complications.