Updated 9/3/2026
The two most commonly used approaches in penile implant surgery are the penoscrotal approach, in which the primary incision is made at the junction of the penis and scrotum, and the infrapubic approach, in which the incision is made immediately above the base of the penis.
At Perito Urology, Dr. Paul Perito primarily uses a minimally invasive infrapubic approach, for several reasons.
1. The Primary Incision Is Above the Penis Rather Than Through the Scrotum
With the infrapubic approach, the primary skin incision is positioned just above the base of the penis. This allows the surgeon to access the erectile bodies of the penis and place the components of a three-piece inflatable penile prosthesis without making the primary surgical incision through the scrotum.
A peer-reviewed review of the infrapubic approach describes avoidance of a scrotal incision as one of its advantages and notes that reduced surgical dissection of scrotal tissue may decrease postoperative scrotal bruising and facilitate rehabilitation.
2. The Infrapubic Approach Provides Direct Access for Reservoir Placement
A three-piece inflatable penile implant consists of cylinders inside the penis, a pump located in the scrotum, and a fluid reservoir typically positioned within the lower abdomen or pelvis.
The infrapubic incision gives the surgeon relatively direct access to the area used for reservoir placement.
The International Penile Prosthesis Implant Consensus Forum notes that the infrapubic approach can provide direct visualization during reservoir insertion. By comparison, traditional reservoir placement through a penoscrotal approach may require accessing the reservoir space from a more distant incision.
For an experienced infrapubic implant surgeon, this direct access can make reservoir placement a more efficient part of the operation.
3. There Is Less Surgical Dissection Within the Scrotum
Although the pump of a three-piece inflatable penile prosthesis ultimately sits inside the scrotum, the infrapubic approach does not require the same primary scrotal incision used in a penoscrotal implantation. Less of the operation is performed through surgically opened scrotal tissue.
Individual recovery still varies, and bruising, swelling and discomfort can occur after any penile implant operation.
4. The Approach Can Be Surgically Efficient
Operative efficiency is one of the characteristics most consistently associated with contemporary infrapubic implantation.
In a matched-pair study comparing minimally invasive infrapubic and penoscrotal penile implant surgery, “Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis,” the infrapubic group had a significantly shorter mean operative time. The study reported mean operative times of 91 minutes for the minimally invasive infrapubic group versus 128 minutes for the penoscrotal group in that particular series.
This conclusion was affirmed by a separate review.
These studies do not mean that every infrapubic operation will be faster than every penoscrotal operation. Operative time depends heavily on surgeon experience, patient anatomy, previous surgery, scar tissue, implant type and whether additional procedures are required.
At Perito Urology, extensive experience and a highly standardized surgical technique are used to further streamline the operation. The details of Dr. Perito’s particular operative method are discussed separately on the Perito Implant™ Technique page.
5. Earlier Implant Activation May Be Possible
A contemporary review published in the International Journal of Impotence Research found that infrapubic implantation appears to be associated with faster time to device activation, while maintaining postoperative satisfaction, quality of life and complication rates comparable to other established approaches.
A later review coauthored by Dr. Perito, “Nuances of infrapubic incision for inflatable penile prosthesis,” also describes postoperative protocols in which appropriately selected and motivated patients may begin using their device relatively early after implantation.
Does the Infrapubic Approach Have Better Outcomes?
Current evidence does not establish that infrapubic implantation produces universally better infection rates, satisfaction, penile length or overall outcomes than a properly performed penoscrotal implantation.
That is why the argument for the infrapubic approach should not be that other approaches are ineffective. Instead, its advantages are primarily anatomical and procedural: the location of the incision, reduced scrotal dissection, direct access for reservoir placement, surgical efficiency and the potential for earlier device activation.
For a surgeon with extensive training and experience using the infrapubic approach, those characteristics can make it an effective and reproducible way to perform three-piece inflatable penile prosthesis surgery.
Is the Infrapubic Approach Right for Every Patient?
The surgical approach should ultimately be individualized.
Previous abdominal or pelvic surgery, obesity, scar tissue, revision surgery, penile anatomy, Peyronie’s disease and other factors can affect how a penile prosthesis operation is planned.
Published literature also identifies potential technical disadvantages of the infrapubic approach, including more limited distal corporal exposure, challenges with pump positioning and the need to carefully protect the dorsal sensory nerves of the penis.
These considerations reinforce an important point: The experience of the implant surgeon with the chosen approach matters more than the name of the incision alone.
The Perito Implant™ Technique
The infrapubic approach itself was developed decades before the modern Perito technique and has been used in penile prosthesis surgery since the early history of inflatable implants.
Dr. Paul Perito’s contribution has been to develop, refine and standardize his own minimally invasive method of performing infrapubic inflatable penile prosthesis surgery.
His original technique was published in The Journal of Sexual Medicine in 2008 and was specifically designed to minimize unnecessary operative steps and improve surgical efficiency.
A list of clinical abstracts and data published and presented by Dr. Perito can be found here.