Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Is there still a place for malleable penile implants in the United States? Wilson’s Workshop #18

International Journal of Impotence Research volume 35, pages 82–89 (2023)Cite this article

Subjects

Abstract

The use of semirigid rod penile prosthesis for the management of erectile dysfunction was first described over 85 years ago. Since then, there have been numerous design advancements leading to improved overall durability, concealability, rigidity, and natural feel. However, the inflatable penile prosthesis (IPP) still has a higher patient satisfaction rate and is currently the most commonly inserted prostheses in the United States. There are still certain situations and conditions where the simplicity of a rod may be preferred over an IPP. A pair of semirigid rods has been shown to have less risk of malfunction and need for revision surgery. In addition, patients with poor manual dexterity, those undergoing a salvage for infection prosthesis and those with a prolonged (> 48 h) priapic episode may be better served with a rod than an IPP. Finally, in patients compromised by infection or priapism, the rods can later successfully be exchanged for an IPP with potentially longer, wider cylinders with resultant greater patient satisfaction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Silicone semirigid penile prostheses.
Fig. 2: Vintage silicone rod prostheses.
Fig. 3: Semirigid mechanical prosthesis.
Fig. 4: AMS purchase of Dacomed produces spectra.
Fig. 5: Jonas malleable prosthesis.
Fig. 6: Previous generation of malleables in US.
Fig. 7: Semirigid rod implants available in US today.
Fig. 8: Corpora cavernosa after priapism.

Similar content being viewed by others

References

  1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54–61.

    Article  CAS  PubMed  Google Scholar 

  2. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200:633–41.

    Article  PubMed  Google Scholar 

  3. Gee WF. A history of surgical treatment of impotence. Urology. 1975;05:401–5.

    Article  CAS  PubMed  Google Scholar 

  4. Goodwin WE, Scott WW. Phalloplasty. J Urol. 1952;68:903–8.

    Article  CAS  PubMed  Google Scholar 

  5. Beheri GE. Surgical treatment of impotence. Plast Reconstr Surg. 1966;38:92–7.

    Article  CAS  PubMed  Google Scholar 

  6. Pearman RO. Treatment of organic impotence by implantation of a penile prosthesis. J Urol. 1967;97:716–9.

    Article  CAS  PubMed  Google Scholar 

  7. Small MP, Carrion HM, Gordon JA. Small-Carrion penile prosthesis. New implant for management of impotence. Urology. 1975;5:479–86.

    Article  CAS  PubMed  Google Scholar 

  8. Henry GD. Historical review of penile prosthesis design and surgical techniques: part 1 of a three-part review series on penile prosthetic surgery. J Sex Med. 2009;6:675–81.

    Article  PubMed  Google Scholar 

  9. Sadeghi-Nejad H. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med. 2007;4:296–309.

    Article  PubMed  Google Scholar 

  10. Subrini L. A biomechanical study of flexible penile implants. Ann Urol. 1993;27:192–6.

    CAS  Google Scholar 

  11. Ferguson KH, Cespedes RD. Prospective long-term results and quality-of-life assessment after Dura-II penile prosthesis placement. Urology. 2003;61:437–41.

    Article  PubMed  Google Scholar 

  12. Eland IA, van der Lei J, Stricker BH, Sturkenboom MJ. Incidence of priapism in the general population. Urology. 2001;57:970–2.

    Article  CAS  PubMed  Google Scholar 

  13. Kohler TS, Wen L, Wilson SK. Penile implant infection prevention part 1: what is fact and what is fiction? Int J Impot Res. 2020. https://doi.org/10.1038/s41443-o20-0326-5.

  14. Stein DM, Flum AS, Cashy J, Zhao LC, McVary KT. Nationwide emergency department visits for priapism in the United States. J Sex Med. 2013;10:2418–22.

    Article  PubMed  Google Scholar 

  15. Tausch TJ, Zhao LC, Morey AF, Siegel JA, Belsante MJ, Seideman CA, et al. Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism. J Sex Med. 2015;12:824–6.

    Article  PubMed  Google Scholar 

  16. Ralph DJ, Garaffa G, Muneer A, Freeman A, Rees R, Christopher AN, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009;56:1033–8.

    Article  PubMed  Google Scholar 

  17. Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014;114:576–81.

    Article  PubMed  Google Scholar 

  18. Sedigh O, Rolle L, Negro CL, Ceruti C, Timpano M, Galletto E, et al. Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res. 2011;23:158–64.

    Article  CAS  PubMed  Google Scholar 

  19. Zacharakis E, De Luca F, Raheem AA, Garaffa G, Christopher N, Muneer A;etal. Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders. Scand J Urol. 2015;49:468–71.

    Article  PubMed  Google Scholar 

  20. Brant MD, Ludlow JK, Mulcahy JJ. The prosthesis salvage operation: immediate replacement of the infected penile prosthesis. J Urol. 1996;155:155–7.

    Article  CAS  PubMed  Google Scholar 

  21. Mulcahy JJ. Long-term experience with salvage of infected penile implants. J Urol. 2000;163:481–2.

    Article  CAS  PubMed  Google Scholar 

  22. Pineda M, Burnett AL. Penile prosthesis infections-a review of risk factors, prevention, and treatment. Sex Med Rev. 2016;4:389–98.

    Article  PubMed  Google Scholar 

  23. Kohler TS, Modder JK, Dupree JM, Bush NC, McVary KT. Malleable implant substitution for the management of penile prosthesis pump erosion: a pilot study. J Sex Med. 2009;6:1474–8.

    Article  PubMed  Google Scholar 

  24. Gross MS, Phillips EA, Balen A, Eid JF, Yang C, Simon R, et al. The malleable implant salvage technique: infection outcomes after mulcahy salvage procedure and replacement of infected inflatable penile prosthesis with malleable prosthesis. J Urol. 2016;195:694–7.

    Article  PubMed  Google Scholar 

  25. Habous M, Tealab A, Farag M, Soliman T, Williamson B, Mahmoud S, et al. Malleable penile implant is an effective therapeutic option in men with peyronie’s disease and erectile dysfunction. Sex Med. 2018;6:24–29.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ghanem HM, Fahmy I, el-Meliegy A. Malleable penile implants without plaque surgery in the treatment of Peyronie’s disease. Int J Impot Res. 1998;10:171–3.

    Article  CAS  PubMed  Google Scholar 

  27. Montorsi F, Guazzoni G, Bergamaschi F, Rigatti P. Patient-partner satisfaction with semirigid penile prostheses for Peyronie’s disease: a 5-year followup study. J Urol. 1993;150:1819–21.

    Article  CAS  PubMed  Google Scholar 

  28. Kim YD, Yang SO, Lee JK, Jung TY, Shim HB. Usefulness of a malleable penile prosthesis in patients with a spinal cord injury. Int J Urol. 2008;15:919–23.27.

    Article  PubMed  Google Scholar 

  29. Zermann DH, Kutzenberger J, Sauerwein D, Schubert J, Loeffler U. Penile prosthetic surgery in neurologically impaired patients: long-term followup. J Urol. 2006;175(3 Pt 1):1041–4. discussion 1044.

    Article  PubMed  Google Scholar 

  30. Lacy JM, Walker J, Gupta S, Davenport DL, Preston DM. Risk factors for removal or revision of penile prostheses in the veteran population. Urology. 2016;98:189–94.

    Article  PubMed  Google Scholar 

  31. Minervini A, Ralph DJ, Pryor JP. Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures. BJU Int. 2006;97:129–33.

    Article  PubMed  Google Scholar 

  32. Casabe AR, Sarotto N, Gutierrez C, Bechara AJ. Satisfaction assessment with malleable prosthetic implant of Spectra (AMS) and Genesis (Coloplast) models. Int J Impot Res. 2016;28:228–33.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Baylor University, Houston, TX, USA

    Mohit Khera

  2. Department of Urology, University of Alabama, Birmingham, AL, UK

    John Mulcahy

  3. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Lexiaochuan Wen

  4. Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA

    Steven K. Wilson

Authors
  1. Mohit Khera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Mulcahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lexiaochuan Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven K. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lexiaochuan Wen.

Ethics declarations

Conflict of interest

MK: Consultant Boston Scientific. JM: Consultant Boston Scientific, Coloplast. LW: none. SW: Consultant Coloplast, International Medical Devices. Lecturer Boston Scientific Stockholder NeoTract

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khera, M., Mulcahy, J., Wen, L. et al. Is there still a place for malleable penile implants in the United States? Wilson’s Workshop #18. Int J Impot Res 35, 82–89 (2023). https://doi.org/10.1038/s41443-020-00376-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00376-6

This article is cited by

Search

Advanced search

Quick links