A novel approach for removal of an inflatable penile prosthesis reservoir using laparoscopic instruments

Abstract

In the setting of an infected inflatable penile prosthesis (IPP), removal of the reservoir is a surgical challenge. We describe a novel technique for IPP reservoir removal at the time of IPP explantation utilizing laparoscopic instruments. We present two cases of infected IPPs requiring complete removal of all components of the implant. The corporal cylinders and scrotal pump were removed via a single penoscrotal incision. Through the same incision, a lighted, hand-held retractor was used for visibility, and laparoscopic instruments were utilized to dissect the tissue surrounding reservoir and the attached tubing until free. Then, a completely intact reservoir was easily removed. Infected IPP reservoirs were successfully removed in this fashion without any complication. This new technique not only facilitated the safe removal of the reservoir, but also enhanced surgical efficiency by eliminating the need for additional incisions. We performed a review of current literature concerning techniques and indications for removal of IPPs and the reservoir. In the setting of an infected penile prosthesis, all components of the implant should be removed. Removal of the reservoir has been surgically difficult due to its location, either deep in the space of Retzius or high in the abdomen between the muscular fascias. Our new technique provides an innovative solution for reservoir removal with the use of laparoscopic instruments via a single penoscrotal incision. We have found that this technique overcomes the challenge of a cumbersome blind dissection and the need for the second incision.

Case series – Small bowel obstruction secondary to retained male urinary and sexual prostheses reservoirs

“…12 In standard practice, a defective or infected implant reservoir is left in place as removal can be surgically challenging due to its location. 13 Recently, however, Staller et al 14 described a novel approach for removal of a reservoir using laparoscopic instruments in which the a single penoscrotal incision is made and through the same incision, a lighted, hand-held retractor is used for visibility, and laparoscopic instruments are utilized to dissect the tissue surrounding reservoir and the attached tubing until the reservoir is freed. Through this technique, there is no need for a second incision in an infected field, which not only reduces the risk of exposure to infection but also improves postoperative pain control.…”

“…Through this technique, there is no need for a second incision in an infected field, which not only reduces the risk of exposure to infection but also improves postoperative pain control. 14 Therefore, through this novel approach, we encourage explantation of reservoirs, when possible, in order to avoid the risk of potential long-term complications with retained prosthetic components.…”

Alternative surgical approach for inflatable penile prosthesis removal

“…Staller et al published in 2016 the first article on the removal technique of infected IPP. The corporal cylinders and the pump were removed through a penoscrotal incision, while the reservoir was extracted using laparoscopic camera and instruments introduced through the same incision [9]. The transurethral removal is inappropriate in the case of infected IPP, because the healing of the iatrogenic caverno-urethral fistula will be impaired [10].…”