OBJECTIVES: To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria. PATIENTS AND METHODS: We conducted a retrospective single-centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently, cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long-term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non-validated questionnaires. The data were analysed using non-parametric tests, multivariate logistic regression analysis, and a Kaplan-Meier survival curve. RESULTS: The mean follow-up was 20 months. In all, 88% of patients were satisfied with the result, although only 77% used their device for sexual intercourse. The overall 5-year device survival was 78%, with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only type of phalloplasty significantly affected the infection risk (P = 0.013). CONCLUSIONS: Implantation of a PP into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.