A three-piece inflatable penile prosthesis is the most advanced surgical option for men with erectile dysfunction who don’t respond to other treatments. It consists of two inflatable cylinders placed inside the penis, a fluid reservoir implanted in the abdomen, and a pump hidden in the scrotum. When the pump is squeezed, fluid moves from the reservoir into the cylinders, creating a natural-looking erection; pressing the release valve drains the fluid back, returning the penis to a flaccid state. This design allows for the most natural appearance and feel, both when erect and when soft, and offers better concealability than malleable implants. The main drawbacks are the need for surgery, risk of infection or mechanical failure, and the complexity of the device, but satisfaction rates are very high among patients and partners.