Emerging complications after ectopic placement of reservoirs during inflatable penile prosthesis surgery: a multi-institutional experience
Clavell Hernandez, J1; Ring, J 2; Trost, L3; Köhler, T4; Wang, R1
1: University of Texas McGovern Medical School at Houston, TX, USA; 2: Southern Illinois University School of Medicine, IL, USA; 3: Mayo Clinic, Rochester, MN, USA; 4: Mayo Clinic, Rocheseter, MN, USA
Objective: Ectopic placement of reservoir during inflatable penile prosthesis (IPP) implantation is a commonly used surgical technique to avoid potential risks for bladder, bowel and vascular injury. The purpose of this study was to look at the arising mechanical failure and complications related to ectopic placement of reservoirs.
Methods: We retrospectively reviewed databases of IPP surgeries in three institutions (UTH/MDA, SIU, Mayo) from February 2011 to December 2016. Only AMS IPP with conceal reservoir and Coloplast IPP with cloverleaf reservoir with ectopic placements were included in this study. The reservoir placement location and the volume of saline used to fill the reservoir were recorded. The mechanic failure and complications related to penile implants were reviewed.
Results: A total of 547 IPPs (265 AMS and 282 Coloplast) with ectopic reservoir placements were performed by three surgeons from February 2011 to December 2016. There are 11 cases (2%) with reservoir related mechanic failure and complications that required revision surgeries. There were four cases with conceal reservoir leaking (0.7%) with 2/4 defects identified at the reservoir fold line. There were three cases (0.5%) that required revision due to abdominal muscular pain caused by intra-fascia placement of the reservoirs (two cloverleaf and one conceal reservoir). Three conceal reservoir tubing torsions were found that caused blockage of fluid transportation which also required surgical revision. One reservoir was found to be intraperitoneal via unrelated imaging which led to revision surgery for repositioning. By comparison, complication rate did not differ (p=0.59) from traditional reservoir placement in the space of retzius and was 1.3% (4/302: herniation (2), conceal torsion (1) and bladder erosion (1)).
Conclusion: Ectopic placement of reservoir is mechanically reliable. However, there are associated risks of reservoir leakage, tubing torsion and unintended reservoir malposition that may require surgical revision. Moreover, we need to inform patients that there is a possibility of reservoir-related abdominal muscular pain when the reservoir is placed ectopically that may require subsequent reposition.
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