Update on penile prosthesis

Over the past decades, penile prosthesis surgery has evolved from a final-line treatment for severe erectile dysfunction into a refined, reliable, and highly individualized procedure that restores both function and quality of life. Technological innovation, improved surgical strategies, and a better understanding of patient expectations have reshaped the field. Yet, as this progress unfolds, new challenges and questions continue to emerge: how can we further improve penile length and esthetics, minimize infection, and extend device longevity? This Special Issue published in Asian Journal of Andrology, “Update on penile prosthesis”, brings together a series of articles that capture the current state of the art and offer an insight into the future of prosthetic urology. These contributions, written by leading experts in the field, cover a spectrum of relevant topics ranging from surgical refinement to long-term outcomes, from anatomical complexities to innovative device design. One of the most common and emotionally important concerns among men undergoing implantation is the perception of penile shortening. Lo Re et al.1 provide an excellent overview of the available methods to address this issue. The authors explore a number of advanced surgical options, such as sliding and modified sliding techniques, multiple slice methods, and circumferential incision with grafting, that can be performed alongside inflatable penile prosthesis (IPP) placement. They also discuss adjunctive procedures like ventral phalloplasty and suprapubic lipectomy to enhance perceived length. The review underscores that, although evidence remains limited, well-selected patients can achieve both functional and esthetic benefits. The message is clear: in prosthetic surgery, patient satisfaction depends not only on mechanical success but also on restoring body image and self-esteem. Innovation is underlined by the article of Pozo et al.,2 a comprehensive narrative review summarizing the most recent technological and procedural developments. The authors describe how the evolution of device coatings, disposable tools, and refined surgical instrumentation has helped reduce infection risk and operative complications. They also emphasize advances in perioperative management, such as multimodal analgesia and regional nerve blocks, that have improved postoperative comfort and recovery. Perhaps most excitingly, the review looks ahead to emerging technologies like shape-memory alloys and electronically controlled implants, which could mark the next frontier in prosthetic function and patient autonomy. The technical aspects of reservoir placement continue to generate discussion and research interest. Sedigh et al.3 provide a thoughtful analysis of the available approaches, from traditional space of Retzius placement to intraperitoneal, high submuscular, and lateral retroperitoneal alternatives. The article highlights the advantages and limitations of each method, stressing that no single “gold standard” exists; rather, the optimal technique should be guided by patient anatomy, prior surgery, and surgeon experience. This individualized approach reflects the maturation of the field toward precision surgery rather than rigid protocols. Another valuable contribution by Ioannis et al.4 offers an extensive overview of the evolution of penile prosthetic devices, from the early malleable models to the modern three-piece inflatable systems. The review emphasizes the major steps forward achieved through hydrophilic and antibiotic coatings, parylene microcoatings, and improved pump design, all of which have significantly reduced infection rates and mechanical failures. Importantly, the authors remind us that malleable prostheses still have an important role, especially for patients with limited hand dexterity or those requiring salvage implantation. This balanced discussion of both historical perspective and future direction makes the article an essential reference. Beyond surgical technique, attention has increasingly turned to maximizing postoperative outcomes and rehabilitation. Łaszkiewicz et al.5 systematically review 10 years of evidence on adjunctive strategies aimed at improving penile length, curvature, and overall sexual function. The findings support a multimodal approach, combining intraoperative methods such as corporal incision and grafting with postoperative vacuum therapy, early device activation, and phosphodiesterase type-5 inhibitors. The review demonstrates that penile prosthesis implantation today should be viewed not only as a technical procedure but also as a comprehensive therapeutic process. The long-term durability of prosthetic devices is a cornerstone of patient satisfaction and clinical confidence. Moncada et al.6 present one of the most robust longitudinal analyses in the literature. Covering nearly three decades and more than 400 patients, the study demonstrates interesting survival rates, over 95% at 1 year and nearly 80% at 10 years, with low rates of mechanical failure and infection. These findings validate the reliability of contemporary three-piece IPPs and underscore how steady, incremental refinements in device engineering have yielded lasting clinical benefit. Finally, Chung et al.7 addresses one of the most technically demanding scenarios in prosthetic surgery. The fibrosed corpora, often resulting from Peyronie’s disease, priapism, or previous infection, poses challenges for even the most experienced surgeons. This practical article provides step-by-step insights into preoperative optimization with vacuum therapy and pharmacologic agents, intraoperative strategies using specialized instruments, and postoperative rehabilitation to enhance cosmetic and functional outcomes. It is focused on the value of surgical craftsmanship, patience, and attention to detail. Taken together, these seven contributions highlight the remarkable progress achieved in penile prosthesis surgery, progress that has transformed a high-risk, low-satisfaction procedure into a safe, durable, and highly customizable treatment. They also make clear that innovation in this field is not slowing down. As we move forward, the upcoming research should focus not only on refining devices but also on deepening our understanding of patient’s personal outcomes, including satisfaction, partner experience, and psychological well-being. This Special Issue represents both a milestone and a motivator. It celebrates the achievements of the present when encouraging continued curiosity, collaboration, and technical excellence. The story of penile prosthesis surgery is under continuous reinvention, driven by a shared commitment to improving quality of life for men who have often struggled in silence. COMPETING INTERESTS Both authors declare no competing interests.