The 50-Year Evolution of Penile Implants with Prof. Steven K. Wilson

Welcome to a new episode of Doctor Penis. Today, we have an incredible guest in our studio in Rome—a true legend in the field of penile prosthetics.

It is an honor and privilege to introduce Professor Steven K. Wilson. He is the most experienced penile implant surgeon in the world, the father of modern prosthetic implantology, and someone I have personally admired and learned from throughout my career.

I remember it vividly—twenty years ago, you came to the University of Rome to perform three penile implant surgeries. I was very young at the time, and watching you work had a profound impact on me.

That was the moment I knew this would be my path.

For our audience, could you explain what a penile implant is and how the field has evolved over time?

That’s a great question, and this is the perfect time to discuss it because this year marks the 50th anniversary of the three-piece inflatable penile prosthesis.

Fifty years! Professor Wilson tells us that penile implants have now been on the market for half a century.

Yes. The first penile prosthesis was developed in 1973 by a urology professor at Baylor University in Houston, Texas.

The first-generation implant was made entirely of silicone, but it had many flaws. It required a large abdominal incision because the connecting tubes had to be inserted through the inguinal canals.

The procedure was complex, and the device frequently broke.

When exactly was this?

1973. At that time, I had just finished my residency and was looking for a specialty to focus on.

I attended the first training course on penile implants, and in 1974, I performed my first implant surgery.

But back then, the device was far from perfect. It wasn’t truly effective until the mid-1980s, when significant mechanical improvements made it reliable.

By the mid-1980s, we saw a major breakthrough. The mechanical reliability of penile implants improved significantly, making them a viable long-term solution for patients.

At that time, two major companies were leading the field:

• AMS (American Medical Systems) – The original manufacturer of penile prostheses, founded in 1973.
• Mentor – A competitor that entered the market in 1983, bringing further innovation.

This competition led to continuous improvements in the durability, design, and effectiveness of penile implants.

Then, for nearly 30 years, there were no new players in the market—until 2019, when Rigicon introduced their own prosthesis.

Now, I am here in Rome, visiting you, to encourage you to try the Rigicon prosthesis. It offers features that neither AMS nor Mentor provide, including a lifetime warranty.

So, for 50 years, penile implants have continuously evolved. The early devices required large abdominal incisions and were technically challenging to implant.

Initially, we had AMS as the only option. Then, Mentor came into the field. But from 1983 to 2019, there were no other alternatives—until Rigicon entered the market.

Tomorrow, we will perform a Rigicon implant together in the operating room—and it will be my 1,000th implant!

Really? Your 1,000th implant? That’s impressive!

But you still need to do 10 more before you can catch up with me!

It will take me another 10 years to reach your level of experience.

One major difference with Rigicon’s prosthesis is that it comes with a lifetime guarantee, something that wasn’t available before.

Now, let’s talk about surgical techniques. There’s the penoscrotal approach and the infrapubic approach.

Which one do you prefer?

In the early days, everyone used the infrapubic approach, because it was the original technique developed by Dr. Scott.

That was the standard method until 1981.

Dr. Scott was performing a penile implant surgery on a patient who had undergone five previous abdominal surgeries. During the procedure, he encountered a serious complication.

This forced him to think of a new way to insert the implant, leading to the invention of the penoscrotal approach.

After that, the penoscrotal approach became the preferred method because it was easier for the surgeon. However, it was not necessarily better for the patient.

Professor Wilson explains that early penile implants required large abdominal incisions.

Because this was too invasive, surgeons switched to a penoscrotal approach, which was easier for doctors but more painful for patients.

Then, in the early 2000s, Dr. Paul Perito revolutionized the field by modifying the infrapubic approach to be minimally invasive.

At that time, about 85% of surgeons used the penoscrotal approach. But today, the numbers have shifted to 65% penoscrotal and 35% infrapubic.

However, learning this technique is difficult. It’s not something you can just improvise—it requires proper training and expertise.

Do you like Rome, Italy?

I love Rome! The food is amazing, the people are wonderful, and the wine is fantastic. What’s not to love?

Tomorrow, we will perform our surgery, but tonight, we will celebrate with a great dinner.

Thank you, Professor Wilson. It is an honor to have you here in Rome!