Dr. Bhavik Shah: Why Malleable Penile Implants Excel for Specific Patient Groups

In my experience, malleable penile prostheses are particularly beneficial for specific patient groups. These include individuals with multiple comorbidities, those at high surgical risk, and patients with concerns about general anesthesia. The simplicity of the device, with no need for a pump or reservoir, makes it an excellent choice for patients who require a low-maintenance solution.

📌 Guideline Support:
According to the EAU 2024 Guidelines, malleable penile prostheses (MPPs) are recommended for patients with severe cardiovascular disease, neurogenic erectile dysfunction (e.g., spinal cord injury, Parkinson’s disease), and those with limited hand dexterity. The simplified surgical technique and reduced infection risk make MPPs a preferred option in high-risk populations.

One of our patients today had significant scrotal and testicular sensitivity and strongly preferred a device that did not require any scrotal component. In such cases, a malleable implant is a great alternative, especially in circumcised patients, as it allows for a supra-pubic approach, avoiding scrotal manipulation.

📌 Guideline Support:
The AUA guidelines acknowledge that scrotal pain syndromes and hypersensitivity can impact patient satisfaction with inflatable devices. In such cases, a malleable prosthesis with a non-scrotal approach can be considered to improve postoperative comfort.

The biggest advantage of a malleable implant is that it’s always ready to use—there’s no need for a pump. My patients who prefer a straightforward, maintenance-free option are the ones who truly benefit from this design.

📌 Guideline Support:
EAU and AUA recommendations confirm that malleable implants are ideal for patients who lack the manual dexterity to operate a pump. Additionally, infection rates are lower in malleable devices due to the absence of a reservoir, which reduces the risk of reservoir-related complications, such as erosion or migration.

I particularly appreciate Rigicon’s design—it’s soft enough to be comfortable yet provides sufficient axial rigidity for penetrative function. The rounded tip is an excellent feature, as it enhances glans support, which is important for post-prostatectomy patients or those with Peyronie’s disease.

📌 Guideline Support:
Clinical studies highlight that optimal axial rigidity is essential for successful penetration while maintaining flexibility for patient comfort. Additionally, glans support is crucial for post-prostatectomy patients, as loss of erectile tissue following radical prostatectomy can impact prosthesis stability.

The hydrophilic coating is another plus—it enhances antibiotic absorption, which may help reduce infection risk, an important factor in prosthetic surgery.

📌 Guideline Support:
According to the EAU 2024 Guidelines, hydrophilic coatings on penile implants have been shown to reduce bacterial adherence, thereby lowering the risk of postoperative infections. This feature is particularly beneficial in patients with diabetes or immunosuppression, who are at higher risk for prosthesis infections.

While I strongly recommend malleable implants for many patients, I always ensure they understand the potential trade-offs. One key consideration is the permanent semi-rigid state, which may require adjustments for concealment. Additionally, younger patients who desire a more natural erection cycle often prefer inflatable devices.

📌 Guideline Support:
The AUA and EAU both stress the importance of preoperative counseling, noting that patient satisfaction is highest when expectations are aligned with the device’s functionality. Studies show that while IPP users tend to have higher satisfaction rates due to the flaccid state, malleable implants are preferred by those prioritizing ease of use and reliability.

Overall, I find the Rigicon malleable penile prosthesis to be a strong competitor in the prosthetic market, offering an excellent balance between comfort and function. For the right patient, it’s just as good—if not better—than other malleables on the market. My clinical outcomes with this device have been very positive, and I consider it a reliable choice.

“A malleable implant offers simplicity, reliability, and effectiveness for the right patient—it’s about matching the right solution to individual patient needs.”

📌 Guideline Support:
Both the EAU 2024 Guidelines and AUA best practices recognize malleable implants as an effective treatment for erectile dysfunction, particularly in high-risk populations and patients prioritizing ease of use.