What are long-term complication rates after inflatable penile prosthesis (IPP) surgery?

1. Clear claims drawn from the literature — what authors assert and why it matters

Authors consistently claim that IPP provides durable treatment for refractory erectile dysfunction but is accompanied by long-term mechanical and surgical complication risks. Multiple studies report mechanical failure and device removal as leading long-term problems, with survival estimates ranging from about 70% at 10 years to roughly 50% at 20 years in some cohorts ^{[1] [2] [5]}. Systematic reviews covering tens of thousands of patients emphasize that reported removal and failure rates vary substantially across studies and devices, so the central claim is that IPP is effective but not without significant lifetime revision risk that patients should understand before surgery ^{[3] [4]}.

2. What the largest recent reviews say — variability and trends across studies

Recent systematic reviews published in 2025 pooled large numbers of studies and found wide ranges for removal rates (0–52.9%) and infection rates typically under 5%, while erosion and mechanical failure rates displayed substantial heterogeneity ^{[3] [4]}. One 2025 review that covered nearly 93,000 patients reported device infections across studies from 0.03% up to 14.3% and erosion rates up to 32.5%, with mechanical failure exceeding 15% in about half the studies with 5–11 years follow-up ^[4]. These summaries show that device performance has improved with coated devices and modern techniques, but long-term mechanical durability remains the primary driver of re-intervention ^[4].

3. Long-term device survival and re-intervention — cohort data and timelines

Cohort studies with long follow-up find median device survival measured in decades, but sizeable attrition over time. One multi-center analysis reported median device survival of 18.2 years, a 10-year survival probability of 70.6%, and 20-year survival near 48.4%, with an overall complication rate of 19.3% and re-intervention rate of 13.5% ^[1]. Older single-center series similarly show 5-, 10-, and 15-year mechanical survival in the high 80s to mid-60s percentiles, but these figures depend on device generation and patient selection ^{[5] [2]}. Mechanical failure is often the dominant long-term reason for revision, particularly after the first decade of use ^{[2] [3]}.

4. Infection, erosion, and early complications — how frequent and what predicts them

Infection rates after IPP are generally reported as low in modern series but are not zero; pooled ranges across recent reviews span roughly <1% to low double digits depending on definition and era, with most contemporary studies reporting infections under 5% ^{[3] [4]}. Erosion rates are more variable and can be higher in subsets; one review documented erosions up to 32.5% in certain series ^[4]. Early postoperative adverse events, including pain, decreased perceived penile size, and short-term complications, are commonly reported and correlate with preoperative comorbidities, prior urethral or device surgery, and procedural factors, with prior urethral surgery notably associated with higher complication and re-intervention rates ^{[1] [6]}.

5. Patient satisfaction versus complications — the paradox clinicians must convey

Multiple studies show high patient satisfaction despite measurable complication and revision risks. Recent cross-sectional and long-term follow-up studies report satisfaction rates in the 80–90% range even when substantial proportions experience device issues over time ^{[7] [5] [2]}. The 2025 cross‑sectional study documented an average treatment satisfaction score of 75.14 and 89% reported satisfaction, but also noted early and late complaints such as pain and perceived size reduction, and emphasized that expectation management influences reported satisfaction ^[7]. Thus, patients commonly value restored sexual function even when later revisions may be necessary, underscoring the need for comprehensive preoperative counseling about expected durability and potential trade-offs ^{[7] [2]}.

6. Bottom line for patients and surgeons — balancing benefits, risks, and follow-up

Contemporary evidence positions IPP as a durable, effective therapy with quantifiable long-term revision risk driven mainly by mechanical failure and, less commonly, infection or erosion; aggregate long-term complication or re-intervention rates of roughly 10–20% are reported in many recent series, with device survival falling over decades ^{[1] [2] [4]}. Risk stratification should incorporate prior urethral or device surgery and neurologic comorbidities, and modern coated devices and surgical technique reduce infection risk ^{[1] [4]}. Clinicians must communicate both the high likelihood of functional satisfaction and the realistic probability of future interventions so patients can weigh immediate quality-of-life benefits against lifetime device maintenance needs ^{[7] [3]}.