Inflatable and solid implants for penile enlargement

Objective: To compare clinical outcomes, safety profiles, and patient satisfaction between solid silicone implants (Peniflex) and the novel inflatable extracorporeal implant (Penogrande) for penile enlargement, with emphasis on patients with partial erectile dysfunction (ED). Methods: Between 2017 and 2025, 255 patients underwent penile enlargement surgery across seven international centers (Ukraine, Poland, Turkey, Mexico, Oman, United Arab Emirates). Peniflex solid silicone implants were placed in 232 patients; Penogrande inflatable extracorporeal implants were placed in 23 patients. All patients underwent concomitant ligamentotomy for length enhancement and followed a standardized 2-month postoperative stretching protocol. Outcomes were assessed at 2 and 12 months and included dimensional changes, patient satisfaction, sexual function improvement (IIEF-5), and complications. Results: Peniflex implantation resulted in average length gain of 1.47 +- 0.52 cm and girth gain of 4.9 +- 0.61 cm, with 90.1% patient satisfaction. Complications included seroma requiring puncture (37.5%), implant displacement (2.15%), implant prolapse (0.43%), and decreased erection (0.43%). Penogrande implantation demonstrated superior dimensional outcomes: length gain of 3.11 +- 0.83 cm and girth gain upon inflation of 6.7 +- 0.97 cm (p < 0.01 vs. Peniflex). Patient satisfaction reached 91.3% for sexual function improvement, with all patients reporting increased self-confidence. Among patients with partial ED (n = 14), 85.7% reported improved erectile rigidity during implant use, and 78.6% were able to reduce or eliminate PDE5 inhibitor use. Penogrande complications included prolonged seroma requiring three punctures and antibiotics (4.3%), infected hematoma requiring surgical drainage (4.3%), and fibrotic scar impairing pump function requiring surgical revision (4.3%). No Penogrande implants required removal. Conclusion: Both solid silicone implants and the inflatable extracorporeal Penogrande implant achieve high patient satisfaction and meaningful penile enlargement. Penogrande offers superior dimensional gains and unique dual functionality for patients with partial ED, providing both cosmetic enhancement and structural support that improves erectile rigidity. However, the inflatable design introduces unique complications including infectious and fibrotic events that require careful patient selection and counseling.