Surgical treatment for erectile dysfunction began in the nineteenth century, and currently consists primarily of penile prosthesis implantation. There are two types of prostheses: malleable and inflatable. This chapter discusses the important points of patient selection, penile implant techniques, and complications. The other surgical approach for patients, with erectile dysfunction is vascular surgery. Arterial revascularization, a procedure that, when first described in the 1970s, attracted great interest from urologists and vascular surgeons due to its curative nature, is currently used only in very specific cases. Venous surgery, once quite popular in the 1980s and 1990s, is no longer recommended because it has poor results.