Complication of a Penile Prosthesis Reservoir: Venous Compression Masquerading as a Deep Venous Thrombosis

Flanagan, Michael J.; Krisch, Evan B.; Gerber, Walter L.

doi:10.1016/s0022-5347(17)37940-5

“…4,5 The complication of a ureteral compression leading to hydronephrosis by a retained reservoir has never been reported in literature to date, while a case of venous compression by a functioning reservoir was ever reported. 6 In our case, in addition to the inflammatory change around the reservoir, the fluid in the reservoir also had some contribution to the bulky effect, which lead to compression of the ureter. Therefore, evacuation of fluid in the reservoir during explantation of penile implant should be emphasized to minimize the bulky effect, which might compress adjacent organs.…”

Section: Discussionmentioning

confidence: 59%

Compression of ureter caused by a retained reservoir of penile prosthesis

Jiann

¹

,

Cw

²

,

Jt

³

et al. 2005

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“…Vascular injury during or following placement of a reservoir is certainly possible during the digital or sharp dissection to enter the space of Retzius, as the external iliac system is in close proximity. Five cases including the one noted in this article have been reported, where pressure of the reservoir caused subsequent partial venous obstruction with subsequent lower extremity edema [34][35][36][37]. Brison et al reported a case of a 51-year-old man with a prior history of radiation therapy and large bowel diversion for rectal cancer who underwent IPP placement.…”

Section: Vascular Injurymentioning

confidence: 79%

Review of Penile Prosthetic Reservoir: Complications and Presentation of a Modified Reservoir Placement Technique

Levine¹,

Hoeh²

2012

The Journal of Sexual Medicine

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Introduction Multiple modifications have been made to the inflatable penile prosthesis (IPP) since its inception in the 1970s. These modifications have made reservoir-related mechanical malfunctions highly unlikely in current IPP models. Although these complications are rare, it would be incumbent upon the implanting surgeon to be aware of these potential complications, how they present, how they are best treated, and how to prevent them from occurring. Aims The aim of this article was to present our experience with complications associated with penile prosthesis reservoirs, perform a review of the literature regarding reservoir-related complications, and present our modified technique to place the reservoir into the space of Retzius. Main Outcome Measures Reservoir-related complications including inguinal herniation, erosion into bladder or bowel, intraperitoneal reservoir placement with subsequent visceral injury, vascular injury, autoinflation, and infection. Methods We retrospectively reviewed our experience with penile prosthesis reservoir complications or procedures requiring an alternative implantation approach at our center over the past 10 years where over 400 devices were implanted. We also review reservoir-related complications published in the English literature since the 1980s. Results While exceedingly rare, reservoir complications do occur. Six cases from our institution are presented including one reservoir herniation, one postoperative direct inguinal hernia, one bladder laceration during revision surgery, one ectopic reservoir placement due to morbid obesity, one iliac vein compression syndrome, and one vascular laceration during reservoir revision. Reported reservoir complications include inguinal herniation, erosion into the bladder or bowel, intraperitoneal reservoir placement with subsequent injury to the ureter or bowel, vascular injury, autoinflation, and infection. Conclusion Penile prosthesis reservoirs rarely fail mechanically but are associated with a variety of complications or may require alternate implantation technique. In our experience, the Jorgensen scissors technique allows safe entry into the space of Retzius with diminished risk of hernia as well as vascular, bladder, or bowel injury.

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“…With traditional reservoir placement in the space of Retzius, iliac vein compromised by laceration or reservoir pressure causing thrombosis has been reported in the literature on multiple occasions [7–10]. Previous pelvic surgery, as noted in these reports, obviously alters the surgical planes and makes the injury more likely.…”

Section: Discussionmentioning

confidence: 91%

Outcomes of Abdominal Wall Reservoir Placement in Inflatable Penile Prosthesis Implantation: A Safe and Efficacious Alternative to the Space of Retzius

Stember

¹

,

Garber

²

,

Perito³

2014

The Journal of Sexual Medicine

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Introduction Inflatable penile prosthesis (IPP) surgery is a successful therapeutic option for men with erectile dysfunction. Traditional placement of the reservoir in the retropubic space of Retzius is associated with the rare occurrence of significant complications including bladder, bowel, and vascular injury. An alternative site, posterior to the abdominal wall musculature, has been identified as a potentially safer location for reservoir placement. Aims The aim of this study was to describe our technique of abdominal reservoir placement during infrapubic IPP surgery and present our outcomes data. Methods We retrospectively reviewed our experience with abdominal reservoir placement during virgin IPP cases. Reservoirs placed anterior and posterior to transversalis fascia were analyzed separately. Main Outcome Measure The main outcome measures was assessment of reservoir-related complications including palpable reservoir, reservoir herniation, and injuries to bowel, bladder, or major blood vessels. Results There were no injuries to bowel or major blood vessels with abdominal reservoir placement posterior or anterior to the transversalis fascia in properly segregated patients. Conclusion Abdominal reservoir placement is a safe and simple surgical method that can be recommended for most men undergoing IPP placement. Men with a history of pelvic surgery can have the reservoir placed between the rectus abdominis musculature and transversalis fascia, while other men can have the reservoir placed between transversalis fascia and peritoneum in order to avoid a palpable reservoir. By applying this protocol, the catastrophic injuries that occur rarely with retropubic reservoir placement can be reliably avoided.

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Complication of a Penile Prosthesis Reservoir: Venous Compression Masquerading as a Deep Venous Thrombosis

Abstract: We report a case of vascular compromise secondary to the reservoir of an inflatable penile prosthesis. The problem masqueraded as deep venous thrombosis in the lower extremity of a patient 3 years after a spinal cord injury.

Cited by 19 publications

References 9 publications

Compression of ureter caused by a retained reservoir of penile prosthesis

Compression of ureter caused by a retained reservoir of penile prosthesis

Review of Penile Prosthetic Reservoir: Complications and Presentation of a Modified Reservoir Placement Technique

Outcomes of Abdominal Wall Reservoir Placement in Inflatable Penile Prosthesis Implantation: A Safe and Efficacious Alternative to the Space of Retzius

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