Penile Implant – When Does It Make Sense?
A penile implant is an effective solution – but not for everyone and not in every situation.
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A Penile Implant Is Not a First-Line Therapy
Before a penile implant is considered, all other treatment paths should have been reviewed: PDE-5 inhibitors (tablets such as sildenafil or tadalafil), injection therapy (SKAT), or other conservative measures. Only once these options have been exhausted, are not tolerated, or are unsuitable from the outset does the implant become the next sensible step.
The Most Common Indications
Severe ED After Radical Prostatectomy
The most common indication for a penile implant in our practice. After radical removal of the prostate, around 50 percent of men develop severe erectile dysfunction – even when the operation was performed with nerve-sparing technique.
Does surgery have to happen immediately? No. Erectile function can still improve within the first 24 months after prostate surgery. At the same time, experience shows that waiting too long can lead to further changes in the erectile tissue that make later procedures more complex.
Vascular Erectile Dysfunction
Impaired blood flow in the penis is a common cause of erectile problems – caused by arteriosclerosis, diabetes, high blood pressure, or other vascular disease. Only once PDE-5 inhibitors no longer work or are not tolerated does the penile implant become the next sensible option.
Erectile Dysfunction With Induratio Penis Plastica (IPP)
In advanced Peyronie's disease, erectile function can be severely impaired in addition to the curvature. In this case, the penile implant is the gold standard – it treats the loss of erection while also correcting or significantly improving any residual curvature.
Important: waiting too long can make an additional, more involved grafting procedure necessary alongside the implant – increasing the complexity of the surgery and tending to reduce satisfaction.
Special Case: Restoring Length After Long-Standing ED
If severe erectile dysfunction has been present for many years, the penis can shrink due to tissue loss. A high-quality implanted penile prosthesis can, in such cases, largely restore the original length in both the flaccid and erect state.
Age and Surgical Success
Age plays no role in the success of the operation. Studies show that patients under and over 75 years of age achieve identical results and would recommend the implantation at the same rate.
A limitation exists in the case of cognitive impairment such as dementia: if a patient can no longer safely operate the implant, the risk of malfunction increases significantly.
When We Advise Against a Penile Implant
- Medication or other conservative therapies are still effective
- Erectile function may still be in the possible recovery phase after prostate surgery
- A cognitive impairment prevents safe operation of the device
- Unrealistic expectations are present
- Health-related contraindications disproportionately increase the surgical risk
Frequently Asked Questions About Indications
A penile implant only becomes an option once other treatment paths have been exhausted. Occasional spontaneous erections indicate that there is still potential for other therapies.
There is no blanket answer. Recovery of nerve function can take up to 24 months. At the same time, the condition of the erectile tissue should be checked regularly so as not to miss the optimal timing for a possible implantation.
The combination of IPP and ED requires particularly careful planning. In many cases, the penile implant is the most elegant solution, because it addresses both problems in a single procedure.
Schedule a Consultation
Whether a penile implant makes sense for you can only be clarified in a personal conversation.
The first step isn't a procedure – it's a conversation.
Updated on July 22, 2026
