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Inflatable Penile Prosthesis (IPP)

The inflatable penile prosthesis is the gold-standard surgical treatment for erectile dysfunction in patients who have failed or are unsuitable for medical therapy. Modern three-piece devices reliably restore functional erections with high long-term patient satisfaction.

Three-Piece IPP — Components​

All three-piece IPPs share the same component design:[1][2][3]

  1. Paired cylinders — silicone-based, inserted into the corpora cavernosa; available in multiple girths and lengths
  2. Fluid reservoir — typically 65–100 mL saline; placed in the space of Retzius (prevesical) or ectopic submuscular
  3. Pump and release valve — placed in the dependent scrotum for patient activation

Squeezing the pump transfers saline from the reservoir into the cylinders, producing a rigid erection. Pressing the deflate valve returns saline to the reservoir, restoring flaccidity.

Major Devices​

AMS 700 (Boston Scientific)​

  • CX — controlled expansion; classic workhorse cylinder
  • LGX — length + girth expansion; contemporary standard
  • Momentary Squeeze (MS) pump — ergonomic patient interface
  • InhibiZone antibiotic surface coating (rifampin/minocycline)

Coloplast Titan​

  • Single cylinder design with Bioflex polymer (more elastic than the AMS silicone cylinders)
  • One Touch Release (OTR) pump
  • Hydrophilic coating — bonds to dipped antibiotic of surgeon's choice

Contemporary comparative data show equivalent efficacy and satisfaction between AMS 700 and Coloplast Titan; selection is driven by surgeon preference, cylinder feel, pump ergonomics, and patient anatomy.[2]

Two-Piece IPP​

  • Combined pump-reservoir unit in the scrotum + paired cylinders
  • No abdominal reservoir
  • Used when abdominal placement is undesirable (prior radical prostatectomy with complex abdominal anatomy, abdominal radiation)
  • Smaller reservoir volume = reduced rigidity and firmness compared to three-piece
  • Limited use today

Indications​

  • Erectile dysfunction refractory to PDE5 inhibitors
  • Peyronie's disease with severe curvature (combined with plaque incision/grafting)
  • Post-radical-prostatectomy ED not responsive to medical therapy
  • Post-radiation ED
  • Priapism with corporal fibrosis
  • Penile reconstruction after trauma or phalloplasty

Combined with AUS​

IPP and artificial urinary sphincter can be implanted concurrently or staged in post-prostatectomy patients with both ED and SUI. No increased risk of adverse events vs single- or staged-device implantation.[4]

Complications​

  • Mechanical failure — contemporary device 10-year survival ~80–85%
  • Infection — 1–3% with antibiotic-coated devices; higher in high-risk patients (diabetes, immunosuppression)
  • Erosion — cylinder into urethra, pump into scrotal skin
  • Reservoir complications — herniation, intrusion into bladder or bowel
  • Auto-inflation — mostly with older pre-lockout-valve devices

Imaging Considerations​

IPP components are readily identifiable on imaging. MRI is safe; CT shows cylinders, reservoir, and pump clearly. See Chorney et al. 2018 and Chung et al. 2026 for imaging review.[1][5]

References​

1. Chorney ET, Ramchandani P, Jaffe WI, Siegelman ES. CT and MR Imaging Features of Artificial Urinary Sphincters, Penile Prostheses, and Other Devices in the Male Lower Genitourinary Tract. RadioGraphics. 2018;38(3):794–805. doi:10.1148/rg.2018170087

2. Barnard JT, Cakir OO, Ralph D, Yafi FA. Technological Advances in Penile Implant Surgery. Journal of Sexual Medicine. 2021;18(7):1158–1166. doi:10.1016/j.jsxm.2021.04.011

3. Uski ACVR, Piccolo LM, Abud CP, et al. MRI of Penile Prostheses: The Challenge of Diagnosing Postsurgical Complications. RadioGraphics. 2022;42(1):159–175. doi:10.1148/rg.210075

4. Segal RL, Cabrini MR, Harris ED, et al. Combined Inflatable Penile Prosthesis–Artificial Urinary Sphincter Implantation: No Increased Risk of Adverse Events. Journal of Urology. 2013;190(6):2183–2188. doi:10.1016/j.juro.2013.06.084

5. Chung AD, Aswani Y, Tsai LL. Imaging Review of Male Genitourinary Devices and Augmentations. European Journal of Radiology. 2026;199:112829. doi:10.1016/j.ejrad.2026.112829

See also: Malleable Penile Prosthesis, Artificial Urinary Sphincter, Himplant.