Surgical · Severe ED · AUA Endorsed · Last-line treatment
Inflatable Penile
Prosthesis (IPP)
A surgically implanted hydraulic device that enables reliable, on-demand erections in men with severe erectile dysfunction who have not responded to other treatments. The IPP is not a cosmetic enlargement procedure — it is a functional ED treatment with decades of evidence and the highest patient satisfaction rate of any ED intervention.
The IPP is the only surgical procedure in the Surgical Enlargement category with strong AUA endorsement. It belongs here because it is a surgical procedure — but its context, indication, and evidence base are completely different from cosmetic enlargement procedures.
Overview
What is an inflatable penile prosthesis?
An inflatable penile prosthesis (IPP) is a three-component hydraulic device surgically implanted inside the penis and scrotum. It consists of two inflatable cylinders placed inside the corpora cavernosa (the erectile chambers), a fluid reservoir implanted behind the abdominal wall, and a pump placed inside the scrotum.
To achieve an erection, the man squeezes the scrotal pump — transferring fluid from the reservoir into the cylinders, creating a firm erection. To deflate, a release valve returns fluid to the reservoir. The device is completely concealed inside the body and undetectable when flaccid.
This is a last-resort treatment for men whose erectile dysfunction has not responded to all other appropriate treatments. Once implanted, natural erections are no longer possible — the implant replaces normal erectile tissue function. This is an important point that must be clearly understood before proceeding.
Published studies consistently report patient satisfaction rates above 90% for IPP — higher than any oral medication, injection therapy, or other ED treatment. The reason is that IPP provides reliable, on-demand erections regardless of the underlying cause of ED.
For men who have tried and failed multiple ED treatments, the IPP represents a definitive resolution. The high satisfaction rate reflects appropriate patient selection — men for whom all other options have been exhausted.
The IPP does not enlarge the penis for cosmetic purposes. It restores erectile function in men who have lost it entirely. Some men notice modest girth changes from the cylinders — but this is incidental, not the purpose. Men seeking enlargement without ED should explore other options.
Published outcomes
What the evidence shows
IPP has decades of published clinical data — far more than any other procedure in the surgical category.
Consistently reported in large published series — the highest of any ED treatment
High-volume implanters achieve significantly lower rates than low-volume surgeons
Modern devices last 10–15 years before mechanical revision is typically needed
The procedure
What to expect
Comprehensive ED evaluation
Before IPP is considered, a thorough evaluation confirms that all other appropriate treatments have been tried — including oral medications, vacuum erection devices, penile injections (Trimix), and hormonal optimization where relevant.
Surgery — 45–90 minutes
Performed under general or spinal anesthesia. The cylinders are placed inside the corpora cavernosa through a small incision. The reservoir is placed behind the abdominal wall and the pump in the scrotum. Most men go home the same day or after one night.
Recovery — 4–6 weeks
The device is not activated for 4–6 weeks to allow healing. During this period, swelling and discomfort are managed with medication. Most men return to light activity within 1–2 weeks and full activity after 4–6 weeks.
Training and first use
Your surgeon or a trained nurse educator shows you how to operate the pump. The first several activations are done in the office to ensure proper function. Most men find the device intuitive within the first few uses.
Complication rates for IPP — particularly infection — are significantly lower at high-volume centers. Surgeons who place 50+ IPPs per year have substantially better outcomes than those doing fewer than 10 per year. This is one of the most important factors when choosing a surgeon for this procedure.
Ask your surgeon directly: how many IPPs do you place per year? What is your infection rate? What is your revision rate? A qualified, experienced surgeon will answer these questions directly and without hesitation.
Infection — the most serious complication, requiring explantation and reinstallation. Mechanical failure — devices can malfunction and require revision, typically after 10+ years. Cylinder erosion — rare. Scarring from previous surgeries or Peyronie’s disease increases surgical complexity. Discuss your specific risk factors with your surgeon.
Who is a candidate
Appropriate candidates for IPP
IPP is appropriate for men with severe, treatment-resistant ED — not for men seeking cosmetic enlargement or who have not tried other ED treatments.
Severe ED that has not responded to oral medications (Viagra, Cialis), penile injections, or vacuum erection devices
ED after radical prostatectomy — particularly when nerve-sparing was not possible
ED from Peyronie’s disease — IPP can be combined with straightening procedures
Diabetic ED — often severe and refractory to other treatments
ED after pelvic radiation for prostate or bladder cancer
Men who understand and accept that natural erections will no longer be possible after implantation
Common questions
Frequently asked questions
Can I still have an orgasm with an IPP?
Yes. The IPP affects erection mechanism but not the neurological pathways for orgasm and ejaculation. Most men retain normal orgasm and ejaculatory function. Men who have had prostate surgery may have retrograde ejaculation or dry orgasm as a result of that surgery — not from the IPP itself.
Will it look and feel normal to a partner?
Most partners cannot distinguish an IPP-assisted erection from a natural one. The device is fully internal and undetectable when flaccid. When activated, the erection is firm and sustained. The scrotal pump is small and generally not noticed by partners during intimacy.
What happens if the device fails or needs replacement?
Mechanical failure rates are low with modern devices — typically less than 5% over 5 years. When failure does occur, the device can be replaced through a revision surgery. Most men have their first revision after 10–15 years. The revision is generally more straightforward than the original implant surgery, though it carries slightly higher complication risk due to scar tissue.
Is IPP covered by insurance?
IPP for erectile dysfunction is frequently covered by Medicare and many private insurance plans when appropriately documented as medically necessary. Coverage varies significantly by plan. Cosmetic procedures are not covered. Work with your urologist’s office to document the medical necessity and obtain pre-authorization before surgery.
What should I try before considering IPP?
All of the following should be tried before IPP is appropriate: oral medications (PDE5 inhibitors), vacuum erection device, penile injection therapy (Trimix or similar), hormonal optimization if testosterone is low, and ideally shockwave therapy and/or PRP for vascular ED. IPP is a last resort — not because it is a bad option, but because it is permanent and irreversible.
Related
Treatments to try before IPP
Find a high-volume IPP surgeon
Volume matters significantly for IPP outcomes. Search our directory of vetted urologists with IPP experience — or join the forum to hear from men who have been through the procedure.
This page is for informational purposes only and does not constitute medical advice. IPP is a surgical procedure with permanent consequences — always consult a board-certified urologist before making any decision. Results vary by patient and surgeon. PhallusMD does not endorse specific surgeons, devices, or outcomes.