ABSTRACT
Introduction Reliable penile implants were first introduced over 35 years ago, in the early 1970s. At the same time the Scott three-piece inflatable model 1 and Small-Carrion model 2 were introduced. These were soon followed by the Finney Flexirod device 3 and the Jonas malleable device. 4 In the early days of penile implant placement, the semi-rigid rods outsold their inflatable counterparts by a 3:1 margin. Experienced implanters were in short supply and most urologists felt more comfortable inserting the simpler devices with parts contained completely within the erectile bodies. There were problems unique to the inflatable implants such as leaks, cylinder aneurysms, and tubing kinks, which were not seen with the rod-like devices. With time urologists gained experience in placing hydraulic prostheses and successfully managing their associated complications. The manufacturers attended to wear areas by reinforcing or eliminating them and soon the market shifted toward a preference for the inflatable implants, owing to the better quality of erection and the more flaccid resting state that they afforded. In the mid-1980s, American Medical Systems introduced the Hydroflex implant 5 and later the Dynaflex implant and Surgitek Corporation marketed the Flexiflate device. 6 Each of these was composed of paired hydraulic cylinders, one placed in each corporal body. Fluid was transferred between parts of the cylinder by a distal pumping mechanism to give alternating rigidity and flaccidity. Early mechanical failure, patient difficulties in learning the mechanics of inflation-deflation, suboptimal rigidity, spontaneous deflation, and low market share led to the demise of both devices by the late 1990s.
