Purpose of Review
To discuss emerging alternative strategies for reservoir placement during inflatable penile prosthesis surgery.
Innovations in penile prosthesis design have facilitated the development of various alternative approaches for reservoir placement. Avoiding the space of Retzius is particularly appealing in patients with a history of pelvic surgery and/or radiation. The high submuscular technique utilizes a low-profile reservoir in combination with the implant’s lockout valve to allow for safe placement in the potential space between the anterior abdominal wall musculature and the transversalis fascia, far cephalad from the external inguinal ring and without the need for a counter-incision. Multiple recent publications have demonstrated the safety and efficacy of the high submuscular technique.
High submuscular inflatable penile prosthesis reservoir placement is a safe and effective alternative to placement within the space of Retzius.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Perito P, Wilson S. The history of nontraditional or ectopic placement of reservoirs in prosthetic urology. Sex Med Rev. 2016;4(2):190–3. https://doi.org/10.1016/j.sxmr.2015.10.008.
Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med. 2013;10(8):2115–20. https://doi.org/10.1111/jsm.12203.
Pearce SM, Pariser JJ, Karrison T, Patel SG, Eggener SE. Comparison of perioperative and early oncologic outcomes between open and robotic assisted laparoscopic prostatectomy in a contemporary population based cohort. J Urol. 2016;196(1):76–81. https://doi.org/10.1016/j.juro.2016.01.105.
Sadeghi-Nejad H, Munarriz R, Shah N. Intra-abdominal reservoir placement during penile prosthesis surgery in post-robotically assisted laparoscopic radical prostatectomy patients: a case report and practical considerations. J Sex Med. 2011;8(5):1547–50. https://doi.org/10.1111/j.1743-6109.2011.02229.x.
Wilson SK, Henry GD, Delk JR Jr, Cleves MA. The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement. J Urol. 2002;168(4 Pt 1):1475–8. https://doi.org/10.1097/01.ju.0000030603.29170.c2.
Chung PH, Morey AF, Tausch TJ, Simhan J, Scott JF. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology. 2014;84(6):1535–40. https://doi.org/10.1016/j.urology.2014.08.029.
Garber BB, Bickell M. Subcutaneous placement of inflatable penile prosthesis reservoirs. Urology. 2016;88:93–6. https://doi.org/10.1016/j.urology.2015.10.027.
Stember DS, Garber BB, Perito PE. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. J Sex Med. 2014;11(2):605–12. https://doi.org/10.1111/jsm.12408.
Wilson SK, Delk JR. 2nd. Ectopic placement of AMS 800 urinary control system pressure-regulating balloon. Urology. 2005;65(1):167–70. https://doi.org/10.1016/j.urology.2004.09.042.
Morey AF, Cefalu CA, Hudak SJ. High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013;10(2):603–10. https://doi.org/10.1111/jsm.12000.
•• Pagliara TJ, Viers BR, Scott J, Morey AF. Extended experience with high submuscular placement of urological prosthetic balloons and reservoirs: refined technique for optimal outcomes. Urology Practice. 2018;5(4):293–8. https://doi.org/10.1016/j.urpr.2017.06.006. Long-term results of HSM IPP reservoir placement from the first group to describe the HSM technique.
Gross MS, Stember DS, Garber BB, Perito PE. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement. Int J Impot Res. 2017;29(5):215–8. https://doi.org/10.1038/ijir.2017.26.
Karpman E, Brant WO, Kansas B, Bella AJ, Jones LA, Eisenhart E, et al. Reservoir alternate surgical implantation technique: preliminary outcomes of initial PROPPER study of low profile or spherical reservoir implantation in submuscular location or traditional prevesical space. J Urol. 2015;193(1):239–44. https://doi.org/10.1016/j.juro.2014.07.082.
• Ziegelmann MJ, Viers BR, Lomas DJ, Westerman ME, Trost LW. Ectopic penile prosthesis reservoir placement: an anatomic cadaver model of the high submuscular technique. J Sex Med. 2016;13(9):1425–31. https://doi.org/10.1016/j.jsxm.2016.06.012. Cadaveric study which calls into question as to whether reservoirs intended for the HSM space ultimately reside there.
Henry G, Hsiao W, Karpman E, Bella AJ, Carrion R, Jones L, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11(1):273–8. https://doi.org/10.1111/jsm.12361.
Cefalu CA, Deng X, Zhao LC, Scott JF, Mehta S, Morey AF. Safety of the “drain and retain” option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013;82(6):1436–9. https://doi.org/10.1016/j.urology.2013.07.038.
Kohler TS, Benson A, Ost L, Wilson SK, Brant WO. Intentionally retained pressure-regulating balloon in artificial urinary sphincter revision. J Sex Med. 2013;10(10):2566–70. https://doi.org/10.1111/j.1743-6109.2012.02914.x.
Hsi RS, Hotaling JM, Spencer ES, Bollyky PL, Walsh TJ. Isolated infection of a decommissioned penile prosthesis reservoir with Actinomyces neuii. J Sex Med. 2011;8(3):923–6. https://doi.org/10.1111/j.1743-6109.2010.02144.x.
• Clavell Hernandez J, Trost L, Kohler T, Ring J, Traweek R, Alom M, et al. Emerging complications following alternative reservoir placement during inflatable penile prosthesis placement: a 5-year multi-institutional experience. J Urol. 2018. https://doi.org/10.1016/j.juro.2018.10.013. Large, multi-institutional series comparing conventional versus alternative IPP reservoir placement techniques.
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The author declares that he has no conflict of interest.
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Hudak, S.J. Reservoir Placement Considerations During Inflatable Penile Prosthesis Surgery. Curr Urol Rep 20, 8 (2019). https://doi.org/10.1007/s11934-019-0871-y
- Inflatable penile prosthesis
- High submuscular