Diagnosis of erectile dysfunction (ED) is increasing due to the prevalence of cardiovascular disease, diabetes, lifestyle changes, and an aging population. The worldwide prevalence of ED in 2025 was projected to be 322 million men. ED can negatively affect a man's psychosocial health and quality of life. Of all the available treatment options for ED, the penile prosthesis offers the highest patient and partner satisfaction rates (the inflatable type more than the malleable type) and is covered by most insurance plans in the United States. Despite being irreversible and invasive, per the 2018 American Urological Association guidelines, it is valid for men to begin with a penile prosthesis as the first line of treatment. Consequently, approximately 30 000 penile prostheses are implanted annually in the United States. However, surgery carries inherent risks and potential complications, and like any other implant, an inflatable penile prosthesis (IPP) can be complicated by infection, mechanical failure, and malpositioning. Detection of these complications can be challenging at clinical examination, and MRI is the preferred modality to interrogate the IPP. Other imaging modalities such as CT and US may be used according to the suspected complication and provide complementary information. MRI permits anatomic evaluation of the IPP and offers functional assessment by allowing acquisition of images during both the inflated and deflated states. The aim of this article is to familiarize radiologists with the normal imaging appearance and complications of the three-piece IPP for accurate diagnosis and effective communication with referring clinicians. A structured reporting template is proposed to guide clinical practice. [©]RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Schuch and Chojniak in this issue.

Phosphodiesterase type-5 (PDE5) inhibitors are widely prescribed for erectile dysfunction and exert their pharmacologic effects through augmentation of nitric oxide-cyclic guanosine monophosphate signaling, a pathway with important ocular vascular implications. Given the expression of PDE5 within ocular tissues, increasing attention has been directed toward the effects of these agents on intraocular pressure (IOP), ocular blood flow, and glaucoma-related outcomes. Most clinical and experimental studies evaluating PDE5 inhibitors demonstrate no clinically meaningful or sustained effect on IOP across a range of dosing regimens, exposure durations, and patient populations, including individuals with established open angle glaucoma. Although isolated studies have reported transient or modest IOP elevations, these changes were typically small, transient, and unlikely to be clinically significant. In contrast, substantial evidence indicates that PDE5 inhibition increases ocular blood flow, with effects that appear more pronounced in the choroidal circulation than in the retinal vasculature. Human and animal studies have consistently demonstrated increased choroidal perfusion and thickness after sildenafil administration, supporting a preferential choroidal vascular response. Regarding glaucoma, early concerns were largely based on isolated case reports and postmarketing observations. More recent large-scale observational analyses suggest that PDE5 inhibitor exposure is associated with a lower hazard of being diagnosed as a glaucoma suspect or with open angle glaucoma. Collectively, current evidence supports a neutral effect of PDE5 inhibitors on IOP, a consistent enhancement of choroidal blood flow, and a potential protective association with glaucoma, warranting further mechanistic and prospective investigation. In this review, we examine the available clinical and experimental evidence regarding the effects of PDE5 inhibitors on IOP, ocular perfusion, and glaucoma risk to clarify their ophthalmic safety profile and potential therapeutic implications.