The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant

Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie’s disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care — in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant — must be reduced to enable optimization and assessment of outcomes across patient groups. The three-piece inflatable penile prosthesis offers an excellent treatment option for some men with erectile dysfunction, but implant surgery is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. In this Consensus Statement, an international group of key opinion leaders and high-volume prosthetic surgeons review the current guidelines and clinical evidence and present their expert consensus regarding patient selection, technique and complications of inflatable penile prosthesis surgery.