Erectile dysfunction is a common complication after pelvic surgeries, particularly following a prostatectomy. Rehabilitation post-surgery plays a vital role and typically involves the administration of oral medications, intracavernosal injections, and the use of mechanical aids like the Vacuum Device. Despite these efforts, not every patient regains erectile function through rehabilitation alone. One of the primary difficulties in placing penile prostheses in these patients arises from the considerable fibrosis in the corpora cavernosa. These fibrotic areas can result in plaque formation, leading to penile curvature, as well as significant postoperative adhesions within the pelvic region due to the initial surgery, particularly if it was followed by radiation therapy. Intraoperative complications are usually manageable with the right instruments or, if necessary, additional surgical incisions like the suprapubic incision to help with the placement of the paravesical reservoir. We present a case of a penile prosthesis implant in a 61-year-old patient with erectile dysfunction after radical prostatectomy and radiotherapy. The penile prosthesis was placed with penoscrotal approach. The procedure shows the severe fibrosis due to previous pelvic surgery and radiotherapy, which makes this case a good example of a challenging penile prosthesis implant.