The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation


The penoscrotal (PS), infrapubic (IP), and subcoronal (SC) incisions are used for inserting an inflatable penile prosthesis (IPP). Each surgical approach has its advantages and disadvantages and experts continue to debate which technique has the best outcomes. We performed a critical review of the published English-language studies up to April 2020 investigating the PS, IP, or SC approach for IPP placement. The PS approach is the most frequently used incision. The available data do not suggest a difference between PS and IP approach in size of the implanted prostheses, achieved penile length, patient satisfaction, infection rate, and risk of urethral injury. The risk of dorsal nerve injury, even if low, seems to be greater for IP approach. IP technique is associated with shorter operative time and earlier use of IPP compared with PS approach. Despite limited available data it is reasonable to assume that SC approach, compared with other approaches, has longer operative time and similar infection rate. The time to device activation with SC technique could be similar to the IP approach, but there is only minimal data that can confirm this hypothesis.

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Fig. 1: History: Scott’s original suprapubic approach.
Fig. 2: Evolution from metal Scott to Wilson disposable “Scott retractor”.
Fig. 3: History: first description of infrapubic approach.
Fig. 4: History: perineal approach.
Fig. 5: Penoscrotal approach.
Fig. 6: Infrapubic approach.
Fig. 7: Subcoronal approach.
Fig. 8: Skin loss following subcoronal incision.


  1. 1.

    Salonia A, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioglu A, et al. EAU guidelines on sexual and reproductive health. In: European Association of Urology Guidelines. EAU Guidelines Office, Arnhem, The Netherlands; 2020.

  2. 2.

    Wilson SK, Delk JR. Historical advances in penile prostheses. Int J Impot Res. 2000;12:S101–7.

    Article  Google Scholar 

  3. 3.

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

    CAS  Article  Google Scholar 

  4. 4.

    Scott F, Bradley WE, Timm GW. Management of erectile impotence use of implantable inflatable prosthesis. Urology. 1973;2:80–2.

    CAS  Article  Google Scholar 

  5. 5.

    Mobley DF. Early history of inflatable penile prosthesis surgery: a view from someone who was there. Asian J Androl. 2015;17:225–9.

    Article  Google Scholar 

  6. 6.

    Houlihan MD, Köhler TS, Wilson SK, Hatzichristodoulou G. Penoscrotal approach for IPP: still up-to-date after more than 40 years? Int J Impot Res. 2020;32:2–9.

    Article  Google Scholar 

  7. 7.

    Barrett D, Furlow W. Penile prosthesis implantation. In: Segraves R, Schoenberg H, editors. Diagnosis and treatment of erectile disturbances: a guide for clinicians. New York: Plenum Medical Book Co.; 1985. pp. 219–40.

  8. 8.

    Perito PE. Minimally invasive infrapubic inflatable penile implant. J Sex Med. 2008;5:27–30.

    Article  Google Scholar 

  9. 9.

    Palmisano F, Boeri L, Cristini C, Antonini G, Spinelli MG, Franco G, et al. Comparison of infrapubic vs penoscrotal approaches for 3-piece inflatable penile prosthesis placement: do we have a winner? Sex Med Rev. 2018;6:631–9.

    Article  Google Scholar 

  10. 10.

    Levine LA, Becher E, Bella A, Brant W, Kohler T, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine. J Sex Med. 2016;13:489–518.

    Article  Google Scholar 

  11. 11.

    Egydio PH. Surgical straightening with tunical incision and grafting technique-single relaxing incision based on geometrical principles. In: Levine L, editor. Peyronie’s disease textbook: a guide to clinical management. Totowa; Hymana Press; 2006. p. 227–39.

  12. 12.

    Weinberg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Sub-coronal inflatable penile prosthesis placement with modified no-touch technique: a step-by-step approach with outcomes. J Sex Med. 2016;13:270–6.

    Article  Google Scholar 

  13. 13.

    Park SH. Subcoronal inflatable penile prosthesis under local anesthesia. J Vis Surg. 2019;5:65.

    Article  Google Scholar 

  14. 14.

    Trost LW, Boonjindasup AG, Hellstrom WJG. Comparison of infrapubic versus transcrotal approaches for inflatable penile prosthesis placement: a multi-institution report. Int J Impot Res. 2015;27:86–9.

    CAS  Article  Google Scholar 

  15. 15.

    Sharma N, Berookhim B, Nelson C, Jenkins L, Mulhall J. 028 contemporary practice patterns for penile prosthesis implantation. J Sex Med. 2017;14:e13–4.

    Article  Google Scholar 

  16. 16.

    Montague DK, Angermeir KW. Surgical approaches for penile prosthesis implantation: penoscrotal vs infrapubic. Int J Impot Res. 2003;15:S134–5.

    Article  Google Scholar 

  17. 17.

    Shebl SE, Ali S. Infrapubic versus penoscrotal approaches for Implantation of semi-rigid penile prosthesis. Open J Urol. 2017;07:146–58.

    Article  Google Scholar 

  18. 18.

    Grande P, Antonini G, Cristini C, De Berardinis E, Gatto A, Di Lascio G, et al. Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis. World J Urol. 2018;36:1167–74.

    Article  Google Scholar 

  19. 19.

    Gupta NK, Ring J, Trost L, Wilson SK, Köhler TS. The penoscrotal surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:628–38.

    Article  Google Scholar 

  20. 20.

    Jayadevan R, Eleswarapu SV, Mills JN. Infrapubic approach for placement of inflatable penile prosthesis: contemporary review of technique and implications. Int J Impot Res. 2020;32:10–7.

    CAS  Article  Google Scholar 

  21. 21.

    Wilson S, Henry G, Delk J. IPP & AUS through one incision. Int J Imp Res. 2002;2(Suppl 3):533.

    Google Scholar 

  22. 22.

    Vollstedt A, Gross MS, Antonini G, Perito PE. The infrapubic surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6:620–7.

    Article  Google Scholar 

  23. 23.

    Park S, Wilson S, Morey A. Inflatable penile prosthesis implantation is possible under local anesthesia with conscious sedation: technique and results. J Sex Med. 2015;12:39–40.

    Article  Google Scholar 

  24. 24.

    Wilson SK, Mora-Estaves C, Egydio P, Ralph D, Habous M, Love C, et al. Glans necrosis following penile prosthesis implantation: prevention and treatment suggestions. Urology. 2017;107:144–8.

    Article  Google Scholar 

  25. 25.

    Karpman E, Bella A, Brant W, Christine B, Kansas B, Jones L, et al. Pd26-10 outcomes of ipp placement by surgical approach, penoscrotal vs infrapubic, results from a prospective multicenter study. J Urol. 2015;193:e569–70.

    Google Scholar 

  26. 26.

    Antonini G, Busetto GM, De Berardinis E, Giovannone R, Vicini P, Del Giudice F, et al. Minimally invasive infrapubic inflatable penile prosthesis implant for erectile dysfunction: evaluation of efficacy, satisfaction profile and complications. Int J Impot Res. 2016;28:4–8.

    CAS  Article  Google Scholar 

  27. 27.

    Kramer A, Chason J. Residents at the university of maryland medical system provide insight to learning infrapubic approach for ipp surgery: relative benefits but novel challenges exposed in first 15 cases. J Sex Med. 2010;7:1298–305.

    Article  Google Scholar 

  28. 28.

    Candela J, Hellstrom W. Three-piece inflatable penile prosthesis implantation: a comparison of the penoscrotal and infrapubic surgical approaches. J La State Med Soc. 1996;148:296–301.

    CAS  PubMed  Google Scholar 

  29. 29.

    Eid JF. Penile implant: review of a “no-touch” technique. Sex Med Rev. 2016;4:294–300.

    Article  Google Scholar 

  30. 30.

    Carlos EC, Sexton SJ, Lentz AC. Urethral Injury and the Penile Prosthesis. Sex Med Rev. 2019;7:360–8.

    Article  Google Scholar 

  31. 31.

    Sexton SJ, Granieri MA, Lentz AC. Survey on the contemporary management of intraoperative urethral injuries during penile prosthesis implantation. J Sex Med. 2018;15:576–81.

    Article  Google Scholar 

  32. 32.

    Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National practice patterns of treatment of erectile dysfunction with penile prosthesis implantation. J Urol. 2015;193:2040–4.

    Article  Google Scholar 

  33. 33.

    Bogoraz N. On complete plastic reconstruction of a penis sufficient for coitus [in Russian]. Sov Surg. 1936;8:303–9.

    Google Scholar 

  34. 34.

    Lash H, Zimmerman D, Loeffler R. Silicone implantation: inlay method. Plast Reconstr Surg. 1964;34:75–80.

    CAS  Article  Google Scholar 

  35. 35.

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

    CAS  Article  Google Scholar 

  36. 36.

    Small M, Carrion H, Gordon J. Small-carrion penile prosthesis: new implant for management of impotence. Urology. 1975;5:479–86.

    CAS  Article  Google Scholar 

  37. 37.

    Barry JM, Seifert A. Penoscrotal approach for placement of paired penile implants for impotence. J Urol. 1979;122:325–6.

    CAS  Article  Google Scholar 

  38. 38.

    Jonas U, Jacobi GH. Silicone-silver penile prosthesis: description, operative approach and results. J Urol. 1980;123:865–7.

    CAS  Article  Google Scholar 

  39. 39.

    Smith AD. Circumcision incision for insertion of semirigid penile prosthesis. Urology. 1981;18:609.

    CAS  Article  Google Scholar 

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Correspondence to Javier Romero Otero.

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Conflict of interest

SKW is consultant for AMT, Coloplast, International Medical Devices, and Lecturer for Boston Scientific. JRO is proctor and expert advisor for Coloplast, and proctor for Boston Scientific. CM has no conflict of interest to declare.

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Otero, J.R., Manfredi, C. & Wilson, S.K. The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation. Int J Impot Res (2020).

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