Magnetic resonance imaging of penile Prostheses: A pictorial review of normal appearances and complications.

Penile prostheses represent the definitive treatment option for erectile dysfunction refractory to conservative management, and recognition of their imaging appearances and potential complications is essential for radiologists. Magnetic resonance imaging (MRI) has emerged as the optimal imaging modality for post-implantation evaluation, offering superior soft tissue contrast and multiplanar capabilities compared to ultrasound and computed tomography. This review provides a comprehensive overview of penile prosthesis types, including semi-rigid and two- and three-piece inflatable devices, with emphasis on the imaging-relevant anatomical considerations of different surgical approaches. We present standardised MRI protocols for prosthesis evaluation, detailing recommended sequences, imaging planes, and technical parameters. The normal MRI appearances of each prosthesis component are described, including cylinders, pump, reservoir, and connecting tubing. The review illustrates the MRI findings of mechanical complications (fluid leakage, cylinder fracture, aneurysm formation), malpositioning abnormalities (erosion, cylinder crossover, buckling, floppy glans syndrome), and infectious complications, supported by a comprehensive pictorial collection. The complementary roles of computed tomography and ultrasound are also discussed. This pictorial review aims to familiarise radiologists with the expected post-surgical appearances and the spectrum of complications detectable on imaging, enabling accurate diagnosis and timely clinical management.