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What are common complications after penile implant surgery and how do they affect sexual function?
Executive summary
Common complications after penile implant surgery include infection, bleeding/hematoma, device malfunction (mechanical failure), erosion/erosive complications, altered penile sensation or deformity (e.g., floppy glans), and wound problems; these complications can reduce satisfaction, require reoperation or explantation, and in some cases impair sexual function (e.g., altered sensation, inability to use device, or explantation) [1] [2] [3]. Overall complication rates are described as low but vary by patient factors and by whether the operation is a primary or revision implant; infection and mechanical failure are the most commonly highlighted causes of reoperation [4] [5].
1. Infection: the complication that most often forces hard choices
Surgical-site infection after penile prosthesis placement is repeatedly emphasized in the literature as a feared event because it frequently requires device removal (explantation) or extensive salvage measures; infection rates worsen patient outcomes and lower satisfaction scores [2] [1] [4]. Risk factors named include prior surgery or revision procedures (where bacterial biofilm is already present), homelessness or polysubstance use in some series, and longer or more complex procedures [4]. When infection leads to explantation, the patient loses the prosthetic ability to have penetrative erections until a re-implantation is performed, which directly affects sexual function and satisfaction [4] [2].
2. Hematoma and bleeding: early complications that delay recovery
Postoperative bleeding and scrotal hematoma are among the early complications tracked in multicenter registries and single-center studies; hematoma can prompt readmission, drainage, or reoperation and is an important driver of early morbidity [6] [1]. Hematoma and prolonged wound drainage increase infection risk and may delay the time before a patient can safely start using the implant for sexual activity, affecting short‑term sexual function and comfort during recovery [6] [1].
3. Mechanical failure and device malfunction: durability vs. reoperation
Mechanical problems — pump failure, fluid leaks, cylinder malfunction — remain a cause of late reoperation despite design improvements; malleable devices are mechanically simpler but less anatomic, while three-piece inflatable devices are more natural but carry more components that can fail [2] [4]. Mechanical failure can render the device unusable for erection and generally requires revision surgery to restore sexual function [5] [1].
4. Erosion and extrusion: tissue damage that compromises function and cosmesis
Cylinder erosion into the urethra or through the skin, as well as impending erosion from oversized devices or weakened corporal tissue, are described complications that may force device removal and reconstructive steps [7] [8]. Erosion damages local tissue and typically eliminates the ability to use the implant until the problem is treated surgically, with clear negative effects on sexual function and appearance [7] [8].
5. Altered sensation, deformity, and “floppy glans” — function beyond erection
Reports list altered penile sensation, floppy glans syndrome (glans hypermobility or poor coupling with the cylinders), and cosmetic deformities as late complications; these problems can make intercourse uncomfortable or unsatisfying even when the prosthesis is mechanically working [3] [8]. Such complications reduce patient-reported satisfaction and can lead to requests for revision or removal to restore a more normal sexual experience [3].
6. How complications translate into sexual outcomes and satisfaction
Large cohort and registry data show high overall satisfaction after implantation when complications are absent, but patients reporting early or late complications score significantly worse on validated satisfaction measures (EDITS scores), demonstrating a direct link between complications and sexual quality-of-life [3]. Where complications force explantation or leave the device nonfunctional or uncomfortable, sexual penetration and partner experiences are directly impaired [4] [2].
7. Patient and surgical factors that change the risk calculus
Revision surgery, prior pelvic procedures or radiotherapy, comorbidities, and social determinants (e.g., unstable housing, substance use in some studies) increase infection and complication risk; experienced teams and meticulous technique, device selection, perioperative measures and drainage strategies can lower complication rates [4] [8] [6]. The literature stresses that counseling about these risks is essential because complication likelihood and consequences differ by patient and procedure type [8] [4].
8. What reporting gaps and disagreements remain
Available sources provide consistent lists of the common complications (infection, hematoma, mechanical failure, erosion, altered sensation), but incidence rates vary across registries and single‑center reports and some emerging device-specific problems (e.g., Penuma complications) have limited, heterogeneous data — the true long‑term incidence and functional outcomes in certain implant types are incompletely defined [9] [10]. Studies also differ in follow‑up length and outcome measures, so exact probabilities for any one patient depend on their clinical context and the surgical team [6] [2].
If you want, I can summarize typical incidence ranges for each complication from the largest registries, or draft questions to ask a surgeon to better understand personal risk and expected sexual function after recovery.