What are the long‑term outcomes and complication rates of penile prostheses versus intracavernosal injections?

1. What the data actually compares: effectiveness, durability and satisfaction

Comparative series and reviews frame penile prostheses as “more permanent” therapy that restores penile rigidity reliably for intercourse and yields higher satisfaction and greater improvements in validated erectile scores versus ICI and oral agents in many studies ^{[3] [5] [6]}. Longitudinal ICI cohorts show that a core subset does maintain long‑term benefit, but overall many patients discontinue ICI for reasons unrelated solely to efficacy (lack of spontaneity, side effects, partner status), so durability in real‑world practice is limited by adherence rather than physiologic failure alone ^{[3] [7]}.

2. Complication profiles: surgical risks of prostheses versus pharmacologic risks of ICI

Contemporary penile prosthesis surgery carries perioperative and device‑related complications—wound infection, device mechanical failure, erosion/extrusion and rare systemic events—yet contemporary series and guideline reviews report relatively low and declining complication rates with high satisfaction when patients are selected and optimized preoperatively ^{[8] [2] [9]}. Short‑term analyses show 30‑day adverse event rates vary (one series reported an 11.3% overall complication rate including surgical site infections and other perioperative events) but emphasize that modern technique and prophylaxis reduce risks ^{[10] [11]}. ICI complications are non‑surgical but notable: priapism (~7.1% in one long‑term series), penile curvature (~10%), bruising and mild pain, which are uncommon but can be distressing and drive discontinuation ^[4].

3. Long‑term device survivorship and reoperation

Device survival and mechanical failure historically were limiting factors for prostheses, but iterative improvements in inflatable and malleable devices have lowered mechanical failure rates and improved longevity; contemporary reviews emphasize better device survival compared with older eras, although long‑term reoperation risk still exists and must be discussed with patients ^{[9] [2]}. ICI carries essentially no implant‑related reoperation risk but instead incurs ongoing medication use, potential repeated clinic visits, and the lifelong behavioral burden that leads many men to stop therapy even when erections are achievable ^{[3] [7]}.

4. Patient selection, quality of life and hidden agendas in the literature

Guidelines position prostheses as third‑line therapy after less invasive measures fail; this reflects both the surgical risks and the goal of reserving irreversible interventions for refractory cases ^{[1] [2]}. Industry funding, device‑centric series, and single‑center surveys can tilt reported satisfaction and complication numbers; conversely, ICI literature often comes from rehabilitation programs and may underrepresent men who discontinue early and never recontact urology, biasing estimates of real‑world persistence ^{[3] [4]}. The true choice for a patient balances invasiveness, desire for spontaneity, tolerance for injections, comorbidities (eg, diabetes), and risk tolerance.

5. Bottom line for long‑term outcomes and complications

For men who seek a definitive restoration of penetrative function and accept surgical risk, penile prostheses deliver higher satisfaction and durable erectile function with diminishing complication rates in modern series; for men who prefer non‑surgical options, ICI can provide effective erections but has higher long‑term dropout and a small but meaningful rate of local complications such as priapism and curvature ^{[5] [4] [2]}. The literature supports a shared decision approach—prosthesis when conservative measures, including ICI, have failed or are unacceptable; ICI as a valuable, reversible second‑line therapy for many ^{[1] [8]}.