Fact check: What are the most common complications of penis implant surgery?

1. Why infection and erosion dominate the complication headlines

Infection emerges as a leading complication across multiple reviews and systematic studies, with reported infection rates spanning very low single digits up to more than 10% depending on cohorts and definitions; a systematic review compiled studies showing infection rates from 0.03% to 14.3%, underscoring heterogeneity in practice and patient risk ^[1]. Erosion—where device components breach corporal tissue or the urethra—shows similarly wide variability, with reported ranges from 0.02% to over 30% but with most studies clustering below 5%, which suggests that high reported figures reflect select high-risk populations or series with prolonged follow-up ^[1]. Reviews emphasize that preoperative optimization, antibiotic strategies, coated devices, and meticulous surgical technique are the primary levers for reducing infection and erosion risk ^{[4] [3]}. Authors consistently recommend targeted perioperative protocols and attention to comorbid conditions because these measures directly influence infection and erosion outcomes ^[4].

2. Mechanical failure: the delayed problem that shapes device choice

Mechanical failure is a prominent complication with a time-dependent profile: device durability problems increase with longer follow-up, and half the studies with 5–11 years of follow-up reported mechanical failure rates exceeding 15% in at least some cohorts ^[1]. Comparative analyses between inflatable and malleable prostheses find trade-offs: inflatable devices often have higher satisfaction but also higher mechanical failure frequency, whereas malleable devices are praised for simplicity and durability but offer less natural function and spontaneity ^{[2] [5]}. These findings frame device selection as a balance between immediate quality-of-life outcomes and long-term reoperation risk, with mechanical reliability being a key factor for patients with longer life expectancy or limited access to follow-up care ^[2].

3. Anatomy, technique, and rarer but serious tissue complications

Beyond infection and mechanics, surgeons report tissue-related complications—urethral injury, corporal crossover, perforation, and glans ischemia—that can lead to significant morbidity and sometimes necessitate device removal or revision ^{[6] [7]}. These complications are often tied to intraoperative technique, prior pelvic surgery or radiation, and patient vascular status, which is why multiple reviews stress preoperative screening and individualized surgical planning to minimize structural injury ^{[6] [7]}. The literature also documents reservoir-related issues and bleeding as nontrivial contributors to early postoperative complication rates, reinforcing the role of procedural detail and surgeon experience in preventing adverse outcomes ^[3].

4. Who is at higher risk and how reporting skews perceptions

Studies show complication rates vary markedly by patient factors—prior radical pelvic surgery, prior implant revisions, and comorbidities are repeatedly associated with higher rates of erosion and infection; for example, a series reported an overall postoperative complication rate of 32% with erosion and infection more common in patients with prior radical surgery ^[8]. Heterogeneity in reported rates also stems from study design: single-center series, registry data, and systematic reviews capture different populations and follow-up durations, producing a wide spread of complication figures ^[1]. This pattern indicates that headline complication rates must be interpreted in context—patient selection, surgical expertise, device generation, and follow-up length all shape reported outcomes.

5. Prevention, management strategies, and unresolved trade-offs

Contemporary reviews converge on several preventive measures—antibiotic-coated devices, standardized perioperative antisepsis, patient optimization, and salvage surgery protocols—as effective levers to reduce infection and manage it when it occurs ^{[4] [9]}. Immediate salvage techniques and use of temporary malleable implants are presented as management pathways for infected devices in selected patients, showing evolving strategies to preserve function while treating infection ^[9]. Nevertheless, trade-offs remain: strategies that reduce infection (e.g., coated devices, complex irrigation) may not affect mechanical longevity, and device choice continues to require shared decision-making that weighs infection risk, mechanical durability, functional expectations, and access to revision surgery ^{[1] [2]}.