Three-Piece Inflatable Penile Prosthesis Implantation in Clinical Practice

Narrative review declares both major IPP brands roughly equivalent — written by an author with industry ties to both manufacturers

Journal: Urologie (Heidelberg, Germany) | Published: 2026-03-05 | Type: Narrative Review | PMID: 41784791 Authors: Osmonov D, Chomicz A, Merseburger AS, Roesch MC (Universitätsklinikum Schleswig-Holstein, Lübeck; AndroClinic, Białystok) Funding/COI: Funding not listed. Lead author Osmonov has declared conflicts with Coloplast Porgès, Boston Scientific, and Rigicon — three of the primary manufacturers whose products this review evaluates. Remaining authors declare no conflicts.

Summary

This narrative review summarizes clinical practice for three-piece inflatable penile prosthesis (IPP) implantation, covering indications, surgical approach, and complication management based on EAU guidelines and existing literature. It concludes that both dominant devices — the AMS 700 series and the Coloplast Titan — are clinically similar, with "inconsistent minor superiority" alternating between the two across studies. No original data are presented; this is a synthesis of existing evidence, not new research.

Claims

• Three-piece IPP is the gold standard for refractory erectile dysfunction
• Penoscrotal surgical approach offers advantages over infrapubic approach (no specific data cited in abstract)
• Ectopic reservoir placement is described as safe, particularly in patients with prior pelvic surgery
• AMS 700 and Coloplast Titan show "little substantial difference" in outcomes; studies inconsistently favor one over the other
• Both devices include infection prevention mechanisms and auto-inflation prevention valves
• Surgeon preference and clinical judgment are endorsed as the deciding factor in device selection
• Preoperative patient expectations may affect outcomes; further research controlling for this variable is noted as necessary

Study Quality

This is a narrative review, the weakest class of literature synthesis. Unlike a systematic review or meta-analysis, a narrative review has no registered protocol, no explicit search strategy, no quality assessment of included studies, and no protection against selective citation. The authors summarize literature at their discretion, which means findings that contradict the conclusions may simply not appear. No sample sizes, effect sizes, or quality grades are reported for the underlying studies.

The review claims to be grounded in EAU guidelines, which do carry evidentiary weight, but the additional "relevant literature" selection is opaque. The call for "prospective randomized multicenter trials to determine the ideal prosthesis for specific patients" implicitly acknowledges that the current evidence base cannot answer the question this review purports to address.

Red Flags

• Severe COI: Lead author Osmonov has declared industry relationships with Coloplast Porgès, Boston Scientific, and Rigicon simultaneously — the three major IPP manufacturers whose products are compared in this review. This is not a peripheral conflict; it is direct financial entanglement with both sides of the AMS 700 vs. Titan comparison.
• Narrative review design: No search methodology, no PRISMA flow, no quality grading. Cannot distinguish from a curated argument.
• Conclusion undermines the review: If the data inconsistently and minimally favor one device over the other, the review's practical value reduces to surgical technique guidance — yet that guidance lacks quantitative support in the abstract.
• Funding not disclosed: For a review with this COI profile, absence of funding disclosure is notable, not neutral.
• No original data: Nothing here that a clinician couldn't find in the EAU guidelines directly.

Strengths

• Covers a clinically practical scope: indications, perioperative care, technique, and complication management in one place
• Ectopic reservoir placement discussion may be useful for surgeons managing post-pelvic-surgery patients
• Acknowledges the limits of current evidence and calls for RCTs
• Three authors declare no conflicts of interest

Verdict

A narrative review co-authored by someone with simultaneous financial ties to all major IPP manufacturers, concluding that both brands are essentially equivalent, should be read with substantial skepticism. The clinical technique content may have practical utility for surgeons, but the device comparison carries no methodological weight and the COI makes it impossible to assess whether the "little substantial difference" conclusion reflects the literature or the author's relationships. Worth scanning for its surgical technique summary; not a reliable source for device selection guidance.