We developed an algorithm for surgical management and placement of penile prostheses in patients with erectile failure (ED) and Peyronie's disease (PD). We identi®ed 46 men ages 40 to 77 y with PD who could not attain an adequate erection with sexual stimulation and pharmacotherapy. All men were candidates for penile straightening and in¯atable prosthesis placement using the following algorithm. Manual molding was attempted initially, followed by tunica incision for insuf®cient straightening. For tunical defects greater than 2 cm, polytetra¯uoroethylene (PTFE) patch grafting was performed to prevent prosthesis cylinder herniation and recurrent deformity from cicatrix contraction. Mean preoperative penile curvature was 53 degrees (0 ± 90). Prosthesis implantation with manual molding, implant with plaque incision, and implant with plaque incision and PTFE grafting were successfully accomplished in 25 (54%), 12 (26%), and nine (20)% respectively. Mean follow-up was 39 months (range 1 ± 74). Full erectile capacity with a straight phallus was achieved in all patients. Complications included temporary (`8 months) decreased penile sensation in four (9%), mild (`2 cm) penile shortening in three (7%), delayed ejaculation in one (2%), and infection requiring explanation in one diabetic male (2%). All of the implanted prostheses provided satisfactory rigidity with no mechanical failures or recurrent curvature.We conclude that in¯atable penile prosthesis implantation is a safe and effective therapy with a high satisfaction rate in men with ED and PD. The developed algorithm helps de®ne prosthesis placement and straightening techniques to obtain optimal results with minimal complications.