Postoperative Glans Color Changes Following Penile Prosthesis Implantation: Not Always Glans Ischemia

<b>Background/Objectives:</b> Penile prosthesis implantation is a safe and effective treatment for erectile dysfunction, with low complication rates. Glans ischemia is a rare but serious postoperative complication that can lead to irreversible tissue loss. However, not all postoperative glans color changes reflect true ischemia, and distinguishing reversible from irreversible perfusion compromise remains challenging. The objective was to describe the clinical course, management, and outcomes of four patients who developed glans color changes following penile prosthesis implantation, emphasizing the role of glans sensibility in guiding treatment. <b>Methods:</b> We conducted a retrospective case series supplemented with a narrative literature review. Clinical data were obtained from medical records, operative reports, and follow-up visits. Literature searches were performed using PubMed, Scopus, and Google Scholar. <b>Results:</b> Four patients developed postoperative glans discoloration. Two patients, with preserved glans sensibility and no evidence of tissue necrosis, were managed conservatively with cylinder deflation and removal of compressive dressings, resulting in full recovery without tissue loss. Two patients, who exhibited impaired glans sensitivity, developed progressive ischemia. One had prior pelvic radiation, and the other underwent combined grafting and glanspexia. Both required surgical debridement and reconstruction, with permanent tissue loss. <b>Conclusions:</b> Glans color changes after penile prosthesis implantation do not always indicate irreversible ischemia. Preserved glans sensibility is a useful clinical marker of potentially reversible perfusion compromise and may support a conservative management strategy with close monitoring. Conversely, loss of sensation and necrosis should prompt urgent consideration of prosthesis explantation to prevent further tissue loss.