A penile prosthesis, also known as a penile implant, is a surgically implanted medical device designed to provide sufficient penile rigidity for sexual intercourse in men with erectile dysfunction who cannot achieve a satisfactory erection with other treatments or who prefer a definitive surgical solution.
In Turkey, penile implants are sometimes colloquially referred to as a “mutluluk çubuğu,” literally meaning a “happiness stick.” In medical terminology, however, the correct terms are penile prosthesis or penile implant.
An important distinction should be made from the beginning: a penile prosthesis does not increase sexual desire, raise testosterone levels or enlarge the penis. Its primary purpose is to provide reliable mechanical rigidity sufficient for penetrative sexual intercourse.
For men with severe or persistent erectile dysfunction (ED), penile prosthesis surgery can provide a highly effective and predictable solution when appropriate patient selection, surgical technique and preoperative counselling are combined.
Modern urological guidelines consider penile prosthesis implantation an appropriate surgical treatment for men who do not respond satisfactorily to other erectile dysfunction treatments, as well as selected patients who prefer a definitive surgical solution after being fully informed about the advantages, limitations and potential risks of the procedure.
The decision to perform penile prosthesis surgery should not simply be based on the idea that “tablets did not work, therefore an implant is needed.”
Before recommending surgery, the cause and severity of erectile dysfunction, the patient's expectations, penile anatomy, previous operations and accompanying medical conditions should all be assessed.
Penile implant surgery may be considered in men who:
One particularly important group consists of men with Peyronie's disease accompanied by significant erectile dysfunction.
In these patients, surgery may not only provide sufficient penile rigidity but may also allow correction of penile curvature during the same procedure when necessary.
No. Erectile dysfunction has many possible causes.
Low testosterone levels, poorly controlled diabetes, cardiovascular disease, medication-related side effects, psychological factors and other potentially treatable conditions can contribute to erection problems.
For this reason, penile prosthesis surgery should not be planned by evaluating only the penis. The underlying erectile dysfunction as a whole must first be assessed.
Depending on the patient's medical history and examination findings, investigations may include:
The goal is not simply to identify whether a man can receive a penile implant, but to determine whether implantation is truly the most appropriate treatment for that particular patient.
Treatment of erectile dysfunction should be individualised.
Depending on the cause and severity of ED, treatment options may include lifestyle modifications, oral PDE-5 inhibitors, vacuum erection devices and intracavernosal injection therapy.
Low-intensity shockwave therapy (Li-ESWT) may also be considered in selected patients, particularly men with mild to moderate vasculogenic erectile dysfunction.
However, there is no medical rule stating that every patient with severe erectile dysfunction must undergo shockwave therapy before considering a penile implant.
Similarly, regenerative approaches such as PRP and various cellular injections should not automatically be regarded as mandatory steps before penile prosthesis surgery. Evidence supporting these treatments remains less established than for conventional erectile dysfunction treatments.
This distinction is particularly important in men with advanced and permanent organic erectile dysfunction.
Repeating treatments with a low likelihood of success for many months may delay a treatment that could provide a more predictable result. Patients should therefore be informed about realistic treatment alternatives early in the decision-making process.
Not every man experiencing erection problems is an appropriate candidate for a penile prosthesis.
A detailed evaluation should consider:
An active urinary tract infection or systemic infection may require postponement of surgery until the infection has been appropriately treated.
Diabetes itself does not automatically prevent penile prosthesis implantation. However, appropriate glycaemic control is important because diabetic patients may have a higher risk of prosthesis infection.
In men with significant cardiovascular disease, the safety of both surgery and subsequent sexual activity should also be evaluated.
When erectile dysfunction is predominantly psychological and the physiological erection mechanism remains intact, an irreversible surgical treatment such as penile prosthesis implantation would generally not be considered the initial treatment.
Penile implants can broadly be divided into inflatable penile prostheses and malleable or semi-rigid penile prostheses.
A three-piece inflatable penile prosthesis consists of:
When the patient wants an erection, he operates the pump located inside the scrotum. Fluid is transferred from the reservoir into the cylinders, producing penile rigidity.
After intercourse, the deflation mechanism is activated and the fluid returns to the reservoir, allowing the penis to become soft again.
For men who place particular importance on concealability and a more natural flaccid appearance, the three-piece inflatable system is often preferred.
A two-piece inflatable prosthesis combines the reservoir and pump mechanism into a more compact system.
It may be considered in selected patients, including some men in whom placement of a separate abdominal or pelvic reservoir may be less desirable because of previous surgery or individual anatomy.
A malleable or semi-rigid penile implant consists of two bendable rods positioned within the penis.
The penis remains relatively firm at all times. Before intercourse, the patient positions the penis upward manually; afterwards, it can be bent downward for concealment.
The mechanical system is simpler than an inflatable implant, but because the penis remains semi-rigid continuously, concealment under clothing may be less natural.
There is no single penile implant type that is ideal for every patient.
The appropriate prosthesis should be selected according to the patient's anatomy, previous operations, manual dexterity, lifestyle, priorities and expectations.
The three-piece inflatable penile prosthesis is one of the implant systems capable of providing the closest mechanical approximation to a natural erection and flaccid state.
The device consists of inflatable cylinders placed within the two corpora cavernosa, a pump positioned inside the scrotum and a fluid reservoir placed internally.
When an erection is desired, the patient squeezes the pump several times.
Fluid moves from the reservoir into the penile cylinders, causing the penis to become firm.
Following intercourse, activation of the deflation mechanism allows the fluid to return to the reservoir and the penis becomes soft again.
All components are located inside the body.
There are no external tubes, bags, wires or pumps.
One common misconception is that penile implant surgery involves removing the tissues responsible for erection.
This is not how the operation is performed.
Inside the penis are two erectile chambers known as the corpora cavernosa. During surgery, these spaces are carefully prepared and prosthetic cylinders of the appropriate dimensions are positioned within them.
Depending on the patient's anatomy, previous operations and the type of device being implanted, a penoscrotal or infrapubic surgical approach may be used.
If a three-piece inflatable penile prosthesis is selected:
Reservoir positioning may need to be modified in patients who have previously undergone pelvic, bladder or prostate surgery.
Penile prosthesis surgery may be performed under general or regional anaesthesia.
The duration of surgery is not identical for every patient.
Factors that can influence operative complexity include:
For this reason, describing penile prosthesis implantation as an operation that “always takes exactly one hour” is not medically accurate.
One of the technically important stages of penile prosthesis surgery is accurate intracavernosal measurement.
During the operation, the lengths of the right and left corpora cavernosa are measured using specialised surgical instruments.
The cylinder length is then selected according to the patient's actual internal anatomy.
The objective is not to implant the longest possible prosthesis.
An implant that is too long may place excessive pressure on the tissues and can potentially contribute to pain, malposition or erosion.
An implant that is too short may provide inadequate support and create functional problems.
The correct objective is therefore to place a prosthesis that accurately matches the patient's cavernosal anatomy.
This is one of the most important subjects to discuss before surgery.
Standard penile prosthesis implantation is not a penis-lengthening procedure.
The prosthesis is selected according to the dimensions of the patient's existing corporal anatomy.
Men with longstanding severe erectile dysfunction may already have experienced some loss of penile length before surgery.
This can be particularly relevant in patients with:
Placement of a penile implant does not automatically restore all previously lost penile length.
For this reason, discussing realistic expectations regarding penile length before surgery is extremely important.
In many cases, expectation management can be just as important for long-term satisfaction as the brand or model of the prosthesis itself.
Patients frequently ask questions such as:
“Does everyone receive an 18 cm penile implant?”
or:
“What is the largest penile prosthesis available?”
These are not the most useful ways to approach implant selection.
Penile prostheses are available in different cylinder lengths and diameters.
However, the appropriate implant is not selected merely by measuring the externally visible length of the penis.
The determining factor is the internal measurement of the corpora cavernosa during surgery.
For this reason, a prosthesis size that is suitable for one man may be entirely inappropriate for another.
With a three-piece inflatable penile prosthesis, all components of the device remain inside the body.
When the penis is deflated, the presence of the prosthesis is generally difficult to recognise externally.
The pump can be felt inside the scrotum when touched, but it is not externally visible.
Malleable implants are different because the penis remains continuously semi-rigid. They can usually be positioned downward, but concealability under tight clothing may be less natural compared with inflatable prostheses.
For this reason, the choice of implant should take into account not only surgical considerations but also:
One major advantage of a penile prosthesis is that penile rigidity can be produced mechanically without depending on normal penile blood flow.
For example, a man with severe vascular erectile dysfunction may be unable to achieve adequate rigidity despite medication.
A penile prosthesis can mechanically support the penis and provide sufficient firmness for penetration.
However, the prosthesis mainly supports the corporal bodies of the penile shaft.
The glans, or head of the penis, is not directly inflated by the prosthesis.
Glans fullness continues to depend largely on the patient's own blood circulation.
As a result, some men may have excellent shaft rigidity while the glans does not become as firm or full as it did during a natural erection.
This does not necessarily mean that the penile prosthesis is malfunctioning.
A penile implant does not directly produce sexual desire, penile sensation or orgasm.
Its main function is to solve the mechanical problem of insufficient penile rigidity.
If penile sensation, libido and orgasmic function are intact before surgery, implanting a penile prosthesis would not normally be expected to eliminate these functions simply because the implant has been placed.
However, conditions such as:
must be assessed separately.
This distinction is important because a penile implant treats erectile rigidity; it does not automatically treat every component of sexual dysfunction.
Erection and ejaculation are separate physiological mechanisms.
A penile prosthesis is primarily positioned inside the corpora cavernosa and does not directly interfere with the ejaculatory ducts.
Therefore, a man who had normal ejaculation before surgery and has not undergone another operation affecting ejaculation may generally continue to ejaculate after penile prosthesis implantation.
There is, however, an important exception.
Men who have undergone radical prostatectomy for prostate cancer no longer have a prostate or seminal vesicles. Consequently, they do not produce the normal ejaculatory fluid associated with ejaculation.
These patients may still experience orgasm but typically have a dry orgasm, meaning no semen is expelled.
Therefore, neither of the following statements is universally correct:
“Everyone with a penile implant can ejaculate.”
or:
“A penile implant prevents ejaculation.”
The outcome depends mainly on the patient's underlying condition and previous treatments.
With an inflatable penile prosthesis, the patient controls how long the penis remains mechanically rigid.
Once the device is inflated, the penis can remain firm until the patient activates the deflation mechanism.
This differs from a natural erection.
Orgasm or ejaculation does not automatically cause the implant to deflate.
However, this should not be interpreted as meaning that a penile prosthesis treats premature ejaculation.
Premature ejaculation is a separate sexual dysfunction and should be evaluated independently when necessary.
Some swelling, tenderness, bruising and postoperative discomfort around the penis and scrotum can occur after surgery.
During the early postoperative period, the main priorities include:
In men receiving an inflatable prosthesis, operation of the scrotal pump is usually taught after an appropriate healing period.
The timing of sexual intercourse depends on wound healing and the findings at follow-up examination.
For many patients, approximately 4 to 6 weeks of healing is required before sexual activity can be resumed, although the exact period can differ between individuals.
Patients should generally not begin using the prosthesis for intercourse until postoperative evaluation confirms that healing is satisfactory.
Penile implant surgery has high long-term satisfaction rates in appropriately selected patients, but it remains a surgical procedure involving implantation of a permanent medical device.
The two major long-term concerns are:
Other potential complications may include:
Modern surgical techniques, appropriate antibiotic prophylaxis and infection-resistant or antibiotic-coated devices have helped reduce infection rates, particularly in primary implantation procedures.
The individual risk, however, may be different in patients undergoing revision surgery, those with poorly controlled metabolic disease and patients with complex penile fibrosis or previous infection.
Infection involving a penile implant is different from a simple superficial wound infection.
Bacteria can adhere to the surface of the implant and form a protective structure known as a biofilm.
Once biofilm develops, antibiotics alone may not always be sufficient to eradicate the infection.
Depending on the clinical situation, management may require removal of the implant or a specialised salvage procedure in appropriately selected patients.
For this reason, infection prevention begins before the operation.
Important measures include:
Infection prevention is therefore not limited to giving antibiotics after surgery. It is a process that starts with correct patient preparation and continues throughout the surgical and postoperative period.
There is no rule stating that a penile prosthesis must automatically be replaced after ten years.
If the prosthesis continues to function normally and there is no clinical problem, it is not routinely changed merely because a particular number of years has passed.
However, inflatable prostheses are mechanical systems.
Over time, problems may potentially develop in components such as:
Long-term studies have reported device survival of approximately 87% at 5 years, 77% at 10 years and 64% at 15 years.
These figures should not be interpreted as meaning that every prosthesis will fail at a specific date.
They describe the proportion of devices remaining functional at different stages of long-term follow-up.
Some men may therefore use their implants for more than 15 years without significant mechanical problems, while others may require revision earlier.
Mechanical failure of an inflatable penile prosthesis is generally not an immediate medical emergency.
The device may:
The prosthesis is then assessed, and depending on the nature of the problem, one component or the entire system may need to be surgically replaced.
A suspected infection is different.
Redness, worsening pain, discharge, persistent swelling, fever or other findings concerning for infection require prompt medical assessment.
Penile prosthesis surgery is associated with some of the highest satisfaction rates among established treatments for severe erectile dysfunction.
Studies included in contemporary urological literature have reported patient satisfaction rates of approximately 92-100% and partner satisfaction rates of approximately 91-95% in appropriately counselled patients.
However, one important principle should be emphasised:
A technically successful operation does not automatically guarantee a satisfied patient.
A penile implant may function perfectly from a surgical perspective, yet dissatisfaction may still occur if the patient expected:
For this reason, detailed preoperative counselling is one of the most important components of successful penile prosthesis surgery.
Penile prosthesis implantation is a specialised form of prosthetic urological surgery.
The complexity of the operation can increase substantially in patients who:
The surgeon should therefore not only be capable of inserting a primary implant but should also have experience managing complications such as:
Experience in prosthetic and andrological surgery becomes particularly important in complex or revision cases.
For an international or local patient considering penile prosthesis surgery in Ankara, Turkey, the first decision should not be which implant brand or model to purchase.
The first step is to determine why the erectile dysfunction has occurred and whether a penile implant is truly the most appropriate treatment.
During an andrological assessment, factors such as the following should be evaluated together:
In the assessment performed by Prof. Dr. Levent Peşkircioğlu, the aim is not to recommend a penile prosthesis to every patient with erectile dysfunction.
The objective is to identify which patients are likely to benefit from implantation and which type of prosthesis best fits the individual patient's anatomy, medical history and expectations.
Patients who have previously undergone prostate cancer surgery, men with severe erectile dysfunction, patients with Peyronie's disease and those who have failed multiple previous erectile dysfunction treatments may require a more detailed and individualised evaluation.
The cost of penile prosthesis surgery in Turkey in 2026 can vary significantly according to the type and brand of implant selected.
The cost of a three-piece inflatable penile prosthesis is different from that of a malleable penile implant.
Several factors can influence the total cost of treatment, including:
For this reason, a single figure found online should not automatically be considered the standard penile implant surgery price in Turkey for every patient.
International patients researching penile prosthesis surgery cost in Turkey should also clarify what is included in the quoted price.
Important questions include:
The most accurate cost estimate can therefore be provided only after the patient has been medically evaluated and the appropriate prosthesis and surgical plan have been determined.
Coverage of penile prostheses and related surgical costs by the Turkish Social Security Institution (SGK) may depend on several factors, including:
The amount reimbursed by SGK may also differ from the total cost of a specific prosthesis or treatment performed in a private hospital.
For this reason, it would not be accurate to state that SGK always covers the entire cost of penile prosthesis surgery or that it never provides coverage.
Current reimbursement conditions should be checked individually when surgery is being planned.
For international patients travelling to Turkey, private payment and private health-insurance arrangements should be evaluated separately.
Choosing the correct penile implant is important.
However, even more important are appropriate patient selection and realistic expectations.
Before surgery, the patient should clearly understand:
A successful penile prosthesis operation should not be defined simply as technically placing a device inside the penis.
According to Urologist Prof. Dr. Levent Peşkircioğlu, successful treatment involves more than the surgical placement of a penile prosthesis. The patient should understand what can realistically be achieved before surgery, learn how to use the prosthesis correctly after recovery, and receive appropriate long-term follow-up.
The objective of penile prosthesis surgery in Turkey is therefore not simply to implant a device, but to provide a carefully selected patient with a reliable, functional and sustainable solution for severe erectile dysfunction.
Prof. Dr. Levent PeşkircioğluUrology & Andrology
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