Erectile dysfunction (ED) is a long-standing condition that benefits from modern treatments. For those seeking medical attention for ED, it brings a significant negative impact on health-related quality of life and self-esteem. The penile prosthesis represents the last option in the therapeutic hierarchy for this condition, and the last decades have seen major improvements in both mechanics, durability and safety of this implant. Herein, this review highlights the most commonly used penile prosthetic devices, the surgical techniques involved, and the current evidence supporting their safety and effectiveness. Data from the literature consistently supports the inflatable penile prosthesis as the ultimate treatment for ED, despite its irreversible nature, arising from the destruction of the natural tissue involved in erection. We conclude that the penile prosthesis should be offered as the last alternative treatment, only for regaining erectile function but not for the enlargement of the penis.