The optimal malleable penile prosthesis includes an implantable cylinder of fixed length that can be manipulated to achieve penetration when desired while being concealable enough to remain socially and functionally acceptable while not in use. Ideal surgical candidates are those who lack the manual dexterity to operate a 3-piece device and in whom concealment is not of particular concern.4Penile prosthesis surgery in the management of erectile dysfunction. The first type of device described in 1975 was marketed as the semirigid rod prosthesis, and many iterations of this device were attempted by several manufacturers.5The Small-Carrion penile prosthesis: surgical implant for the management of impotence. Just prior, in the 60s and early 70s Egyptian surgeon GE Beheri is credited as performing over 700 implants of polyurethane rods after corporal dilation. His technique was slow to be accepted in the urologic community due to his publications being in plastic surgery journals.6Rodriguez KM Pastuszak AW. A history of penile implants. The eventual incorporation of this technique, combined with NASA innovation resulting in creation of high-grade silicone, culminated in significant improvements in semirigid devices (Figure 1). In the 1980s, Jonas and Jacobi created the concept of a silicone cylinder with a twisted wire core. In one study of 11 patients, there was 100% satisfaction at a mean of 21.7 months follow-up; one early extrusion and one UTI resulted in an 18% early complication rate.7Use of jonas silicon-silver prosthesis in erectile impotence. In 2003, American Medical Systems (AMS, Minnetonka, MN) created a mechanical malleable prosthesis with segmented articulating polyethylene rods for improved range of motion while sustaining sufficient rigidity for intercourse, known as the Dura II.4Penile prosthesis surgery in the management of erectile dysfunction. This was followed in 2004 by the Coloplast (Humlebaek, Denmark) Genesis Malleable prosthesis which increased distal shaft column strength to prevent buckling, and comes in multiple diameters, and can be trimmed to customize the fit intraoperatively (Figure 2). In 2009 AMS developed the Spectra Concealable penile prosthesis which added alternating titanium and polyethylene segments for better concealment. The Spectra was designed with 3 different diameters (9.5, 12, and 14 mm) and 12, 16, and 20 cm lengths and could be customized with snap fit rear tip extenders (RTE). In 2019 AMS released the current iteration, the Tactra malleable penile prosthesis which is a dual layer silicone design constructed around a nitinol core which allows for improvement in durability (Figure 2). The Tactra also has more simplified customization as it comes in 3 diameters (9.5, 11, and 13 mm); each is trimmable in length from ~14 to 27 cm and comes with insertion fit RTE for a more streamlined design. Also in 2019, a third company, Rigicon, received FDA approval for implantation of its Rigi10 MPP which offers up to 135° bending angle. The distal and proximal ends of the synthetic coated, steel core, titanium tipped Rigi10 shaft are designed to maintain a rigid, natural feel while the increased bending angle of the midportion allows for easier implantation through a smaller corporotomy (Figure 2). The Rigicon MPP is offered with a hydrophilic external coating and comes in 2 lengths (23 and 25 cm) and 5 diameters (9–13 mm), and each includes 0.5 and 1 cm RTE for further customization intraoperatively.

Figure 1Early example of silicone rod penile prosthesis.

Figure 2Coloplast Genesis (a), AMS Tactra (b), and Rigicon Rigi10 (c) Malleable Penile Prostheses.