https://www.goldjournal.net/article/S0090-4295(22)00268-0/fulltext
Long-Term Survival Rates of Inflatable Penile Prostheses: Systematic Review and Meta-Analysis
Larry E Miller et al. Urology. 2022 Aug.
What it says, in normal English language:
1. What are they trying to figure out?
They want to know:
* How long IPPs actually last in real life.
* Whether any factors (like time period, patient features, study design) change how long they last.
“Device survival” here means the implant is still inside you and has not needed surgery to fix or remove it for any reason (mechanical failure, infection, erosion, etc.).
2. How did they study it?
This is not one hospital’s series. It is a systematic review plus meta-analysis.
They:
* Searched Medline, Embase, and Cochrane for studies of men who had inflatable implants (no malleables) and at least 5 years of follow-up on device survival.
* Ended up with 12 studies including 20,161 men.
* Median age across studies was 57 years.
They then:
* Pooled the data with a random-effects meta-analysis to estimate survival at 1, 3, 5, 10, 15, and 20 years after surgery.
* Did a “one-study-removed” sensitivity analysis: drop one study at a time and re-run the stats to check if any single study is warping the results.
* Did subgroup analysis to see if things like being an older vs newer study changed survival.
3. The core numbers: how long does an IPP last?
Across all 12 studies and 20,161 patients, they found these survival rates:
* 1 year: 93.3 percent of implants still in with no revision.
* 3 years: 91.0 percent.
* 5 years: 87.2 percent.
* 10 years: 76.8 percent.
* 15 years: 63.7 percent.
* 20 years: 52.9 percent.
From this, they conclude the median device survival time of an inflatable implant is about 20 years. In other words, by around 20 years after surgery, half of the original implants are still there and have never been revised, and half have needed some kind of surgical fix or removal.
Rough translation:
* About three out of four devices are still fine at 10 years.
* Just over half are still fine at 20 years.
4. Newer implants versus older implants
They checked whether implants in more recent studies do better than those in older reports.
Result:
* In newer studies, 5-year survival was 90.6 percent.
* In older studies, 5-year survival was 82.1 percent.
* That difference was statistically significant (P = 0.01).
So implants and/or surgical technique have gotten better over time. The paper does not nail down exactly why, but likely contributors are:
* Better device engineering and coatings.
* Better infection prevention and surgical technique.
* Possibly different patient selection.
They also report that no other patient or study design factor consistently predicted survival across all those studies. Era (new vs old) was the one clear factor.
5. How solid are these results?
In the one-study-removed sensitivity analysis, taking out any single study did not meaningfully change the pooled survival numbers.
That means the 20-year median survival is not being driven by one giant outlier study. It is a fairly stable summary of the whole set of data.
Of course, the usual caveats apply:
* Most of the included papers are retrospective.
* Follow-up may not be perfect in every series.
* Definitions of “failure” can vary slightly between centers.
But for prosthesis data, this is about as comprehensive as it gets right now.
6. Conflicts of interest
Always worth looking at who wrote it.
* Several authors (Bhattacharyya, Patel, Nitschelm) are employees of Boston Scientific, which makes penile implants.
* Miller has a professional relationship with Boston Scientific.
* Khera and Burnett reported no conflicts.
So yes, this is manufacturer-connected work, but the conclusions are pretty conservative: they talk about survival curves, not “perfect devices,” and the numbers match independent long-term series from other groups.
7. What does this mean for an actual patient?
If you imagine a typical guy from these studies, about late fifties at implantation:
* In the first year, roughly 7 percent will need some kind of revision or removal. This is when infections and early mechanical issues show up.
* Between years 1 and 10, the failure risk per year is relatively low. By 10 years, about three quarters of devices are still untouched.
* By 20 years, a bit over half of the original implants are still there.
Now layer in age:
* If someone gets an implant at 65 or 70, there is a good chance they will die with their original device still working.
* If someone gets it at 40–45, they have a longer lifetime for something to eventually fail, so their personal odds of needing at least one revision are higher.
That is the statistical backbone behind the common line “a modern 3-piece implant will probably last you decades, and for many guys will outlive them.”
8. Big picture
The answer, based on more than 20,000 patients, is:
* Most survive very well for at least 10 years.
* About half are still going at 20 years.
* Newer generations are outperforming older ones.
