Penile prostheses reservoire complications: non-contrast Ctscan assessment
Pujol, L1; Torremade, J1; Romero, N1; Ferreiro, C1; Cocera, R1; Riera, L1; Calvo, N1; Vigués, F1
1: Hospital Universitari de Bellvitge, Spain
Objective: In the implantation of three-component penile prostheses (PP), the placement of the reservoir in the Retzius space or in an ectopic location requires experience because it is a blind maneuver. Viscera and vascular structures can be injured and additionally it can be localized in an incorrect space that may cause its herniation. The objective of the study is to evaluate the correct or anomalous positioning of the reservoirs by non-contrast CT scan.
Material and Methods: Retrospective data regarding the implantation of PP reservoirs during the 2009-2016 period were reviewed. Data on the type of PP, surgical technique, associated intra-postoperative complications and radiological studies were analyzed.
Results: In the study period, a total of 117 PP were implanted, 97 of them were three-component PP included in our review. The type of PP implanted were the following: 78 (80.4%) AMS 700 LGX/ CX/ CXR with spherical reservoir, 4 (4.1%) AMS 700 LGX with Conceal reservoir and 15 (15.4%) Titan Touch with Cloverleaf reservoir. In 95.9%, the reservoir was placed in a conventional laterovesical localization (image 1) and in 4.1% in ectopic localization (2 cases of medium-low localization (image 2) and 2 cases of lateral-high localization (image 3)). Vascular and visceral intraoperative complications associated with the reservoir were not observed. During the follow-up, 4.1% of complications associated with the reservoir were observed and they were confirmed by non-contrast CT scan (2 herniations of the reservoir, 1 hydrocele secondary to compression of the inguinal cord and 1 direct inguinal hernia (image 4, 5, 6, 7)
Conclusion: The placement of the reservoir during the implantation of PP is a procedure with a low rate of complications. In spite of this, symptoms of excessive discomfort, poor clinical condition of the patient or the malfunction of the prosthesis should make us think about these complications. The non-contrast CT scan provides a good anatomical evaluation of the reservoirs, being an affordable and useful modality in clinical decision making.
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