When there is lack of efficacy or dissatisfaction with other modalities, penile prostheses are often the best alternative for erectile dysfunction in diabetics. Unlike the other modalities, prosthesis surgery is irreversible in that the corporal tissue is permanently altered such that physiologic erections are no longer possible. If the prosthesis has to be removed, there will be complete ED. While a variety of exotic materials, flaps , and grafts have been used, most contemporary prostheses are hydraulic or semi-rigid. Of all modalities for management of ED, prostheses have the highest satisfaction rates , with 2 large studies demonstrating greater than 95% satisfaction . Although some studies suggest that elevated HbA1c levels may predict a higher rate of infections in diabetics having penile prosthesis surgery, more recent studies refute this. A large study from Wilson, et al demonstrated that neither diabetic status nor preoperative HgA1c were risk factors for prosthesis infection. A more recent study also finds that elevated HbA1c is not a risk factor for infection but notes that short-term poor glucose control (as defined by morning fast glucose levels >200 ng/ml) is, although that data is hampered by very low numbers of patients within that set.