The introduction of penile prosthesis in the early 1970s has been the first breakthrough in the treatment of erectile dysfunction. Since then a variety of treatment options for erectile dysfunction have been developed, including penile vascular surgery, injection therapy, vacuum erection device therapy, intraurethral and oral pharmacotherapy. Although the percentage of men newly diagnosed with erectile dysfunction who undergo surgical treatment has declined, the number of men presenting with erectile dysfunction continues to increase out of proportion to this decline. Moreover, many men that are now effectively managed with medical treatment are likely to require penile prosthesis implantation as their erectile dysfunction progresses. This chapter will focus on the surgical management of erectile dysfunction and in particular on penile prosthesis implantation.