The utilization of PDE-5 inhibitors has led to a decline in penile prosthesis (PP) implantations in recent years. Spinal cord injury (SCI) can cause neurogenic lower urinary tract dysfunction (NLUTD). Depending on the level and completeness of the lesion, various types and degrees of NLUTD occur. For male patients with detrusor overactivity, reflex voiding into urinary condoms can be established. Especially in tetraplegic patients, other options like intermittent catheterization are limited due to restricted hand function. Penile retraction complicates the secure attachment of the urinal condom. Penile prosthesis implantation can increase the adhesive surface area. On the other hand, complications such as erosion and technical failures of the PP are often encountered.
This study aims to examine the long-term results of PP in SCI patients, to determine the treatment's long-term practicability within our patient cohort.

In a retrospective cohort analysis of a tertiary reference centre for SCI we have analyzed the files of all patients receiving PP since 1982 within an observation period until December 2023. Parameters analyzed were age, SCI characteristics, indication for PP, outcome, revisions and complications. Values were calculated as mean and standard deviation. Binary logistic regression analysis was used, to evaluate the predictive effect of age, cardiovascular disease, obesity and diabetes mellitus on the occurrence of complications.

We analyzed the data of 30 men who underwent 42 PP implantations, including 12 (28.6%) re-implantations, over a mean follow-up period of 14.0 ± 8.4 years. 
Level of lesion was cervical in 13 (43.3%) men and thoracic in 17 (56.7%) men, respectively. 
The average age at the time of the first PP implantation was 48.9 ± 13.4 years with an average SCI duration of 25.8 ± 18.1 years.
Indications for PP implantation were penile retraction in 83.3% (25 patients), erectile dysfunction in 10.0% (3 patients), and in 6.7% (2 patients) the reasons were unspecified. 
Among the 42 PP implantations, there were 57 complications, which included 24 explantations (57.1%), 18 revisions due to wound infection or abscess formation (42.9%), 9 revisions for technical defects (21.4%), and 6 skin repositioning procedures (14.3%). 
15 patients (50%) experienced one complication, 5 patients (16.7%) had two complications, and 8 patients (26.7%) presented with three to five complications.
Regression analysis identified coronary heart disease as a significant (p=0.022) predictor for post-implantation complications. In contrast, obesity, diabetes mellitus, and age did not emerge as significant predictors (p>0.05).

The high incidence of clinically relevant complications emphasizes the complexity involved in the surgical and post-operative management of SCI patients undergoing PP implantation. Coronary heart disease is a significant risk factor for complications post-implantation and thus, comprehensive cardiovascular assessments are warranted in the preoperative evaluation.

Despite a decline in usage, PP implantations are still of paramount importance in patients with SCI and reflex voiding suffering from problems with condom fixation. 
The study emphasizes the necessity of meticulous patient selection and thorough preoperative assessments to minimize postoperative complications. A multidisciplinary approach is crucial for ensuring the safety and efficacy of PP implantations especially in this patient group.