Insertion of inflatable Penile Prosthesis (IPP) is a well-established, safe, and effective surgical treatment option for management of end-stage erectile dysfunction. While there have been progressive advances in device durability and reliability, the hydraulic nature of IPP remains an inherent risk of device failure. Revision surgeries for partial or complete implant exchange are often required to resolve such issues.

A retrospective review of all penile prosthesis revision cases in a private urology practice in Melbourne from April 2018 to April 2023 was conducted, identifying patients who received IPP implant surgery (MBS item number 37426) and those who underwent revision surgery (MBS item number 37432).

A total of 218 penile prosthesis revision surgeries were recorded. We excluded 20 cases of malleable penile prosthesis and 22 cases with incomplete data from the medical records. Further excluding the 100 cases of revision surgeries for non-mechanical failure indications, we analysed the remaining 76 IPP mechanical failure revision surgeries, We identified 82 occurrences of IPP mechanical failure. Of all types, device leak or tear in general was the commonest, accounting for 73% of all the failed implants. 63% and 82% of failed implants failed due to device leak or tear for Boston Scientific and Coloplast respectively. Of all locations of failure, the cylinder was the commonest, accounting for 38% of the failed implants. 62% of the failures for Boston Scientific implants occurred at the cylinder, compared to 21% for Coloplast implants. Overall tubing failure accounted for 29% of the failure, most commonly being failure of the pump-cylinder tubing within 3cm of cylinder, followed by pump cylinder tubing within 3cm of pump.

Our study summarised the pattern and incidence of mechanical failures of inflatable penile prosthesis at our urology practice. These findings may inform clinicians and patients during IPP surgery preoperative counselling and decision-making process, as well as providing important feedback to prosthesis manufacturers regarding the focus of future research and development directions.