[Penile implant surgery in Germany-effective, established, yet underused].

backgroundPenile prosthesis surgery represents an established, guideline-based treatment option for therapy-refractory organic erectile dysfunction. Despite continuous technical advances, low complication rates and high patient satisfaction, implantation rates in Germany have remained consistently low for many years.

objectiveTo summarise the historical and technical development of penile prosthesis surgery and to analyse current utilisation data with particular emphasis on potential structural causes of underuse.

resultsModern semi-rigid and inflatable penile prostheses demonstrate high material quality, long-term durability and low infection rates. Long-term studies report functional survival rates of approximately 80% at 10 years, together with excellent satisfaction levels among patients and their partners. In contrast, national and international registry data indicate that only a small proportion of eligible patients-particularly those following radical prostatectomy or with diabetes-associated or vasculogenic erectile dysfunction-receive a penile prosthesis. These findings suggest a substantial gap between evidence-based recommendations and real-world clinical practice.

conclusionPersistently low implantation rates cannot be explained by insufficient scientific evidence or limited patient acceptance. They are more likely attributable to structural factors such as low institutional case volumes, restricted resource allocation and a lack of centralised care. Given the well-documented volume-outcome relationship, increasing life expectancy and the growing importance of quality of life, greater structuring and centralisation of penile prosthesis surgery would appear beneficial.