Malfunction and mechanical failure of the inflatable penile prosthesis: a narrative review of etiologies and management

Background and Objective: Inflatable penile prosthesis (IPP) is a well-established and efficacious treatment for erectile dysfunction. Many improvements have been made to IPP technology since its inception 50 years ago. Despite these advances, mechanical malfunction or failure is inevitable in some devices. In this review, we sought to evaluate mechanical failure rates by reviewing the literature on failure rates of specific components by manufacturers, associated risk factors, and management options. Methods: A narrative review was conducted using specific key terms related to IPPs, IPP malfunctions, and IPP revisions from 1988 to 2023 in PubMed and Google Scholar. Key Content and Findings: Modifications to the IPP have decreased rates of mechanical malfunction and failure. The rate of mechanical failure for AMS 700 CX model ranges from 1.9-7.3%. Mechanical reliability of AMS 700 devices (CX, CXM, Ultrex, LGX, etc.) ranges from 91.6-98.2% at 2-3 years, 90.0-93.3% at 5-6 years, and 76.5-81.3% at 10 years. Weak associations between Peyronie's disease and smoking on mechanical failure risk have been made; however, the evidence is of low quality. Fluid leakage, from tubing fractures or cylinder tears, is the most common cause of mechanical malfunction and failure. Coloplast devices have higher rates of tubing fracture whereas American Medical Systems devices have a more even distribution of component failure. Concern over infection risk when retaining some components during an IPP revision has left surgeons unclear on how to approach a malfunctioning device due to mechanical failure. Recent evidence has shown a higher rate of infectious and non-infectious complications when revising only the malfunctioning component(s). Conclusions: Mechanical malfunction and failure rates are highly variable and no consistent risk factors for failure have been clearly established. Complete device replacement is associated with less morbidity than revising only the malfunctioning component. Overall, the quality of data on the incidence and management of IPP mechanical malfunction is limited, and further data is needed to better understand the incidence, risk factors, and ideal management strategies.