Erosion of an Inflatable Penile Prosthesis Reservoir into the Bladder, Presenting as Bladder Calculi

Introduction There have been many advances in the inflatable penile prosthesis (IPP) since the 1970s. While these devices were initially fraught with mechanical malfunction, the most recent models prove to be much more reliable. Although reservoir complications are not common, when they do occur, it typically involves damage to the surrounding tissues. The ability to recognize and treat these complications is paramount for any surgeon that routinely places IPPs. Aim The aim of this article was to present a unique reservoir-related complication as well as perform a literature review of reservoir-related complications and techniques for reservoir placement, and provide a summary of dimensions and technical aspects of commonly used reservoirs. Methods We reviewed a unique reservoir-related complication that presented to our institution with urinary retention and constipation. We also reviewed reservoir-related complications since 1984, reviewed the most recent surgical techniques involved in reservoir placement, and summarized the dimensions and technical characteristics of both the American Medical System® and Coloplast® reservoirs. Main Outcome Measure A reservoir-related complication that resulted in urinary retention and constipation is the main outcome measure. Results Although uncommon, reservoir complications do occur. The most common case report complication in the published literature is bladder erosion followed by external iliac compression, ileal conduit erosion, and small bowel obstruction. The case that presented at our institution was the result of a reservoir that was improperly placed in the perineum, causing urinary retention and constipation due to the compression of the bulbar urethra and rectum. Conclusions In this era, mechanical failures of IPP reservoirs are rare as most complications occur due to damage of the surrounding tissues. Prevention, diagnosis, and treatment of these complications are important for any surgeon that implants IPPs.

Section: Resultsmentioning

confidence: 99%

Section: Reservoir Placement Techniquesmentioning

confidence: 99%

Tips and Tricks of Inflatable Penile Prosthesis Reservoir Placement: A Case Presentation and Discussion

Simon¹,

Hakky²,

Henry

et al. 2014

“…All experienced implanters have performed cystoscopy on IPP patients and seen the imprint of the reservoir of the superior bladder wall as the bladder fills with irrigation fluid. The literature is replete with case reports of bladder laceration or erosion related to reservoir placement [13–18]. Erosion seems more likely in men with a history of RRP [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Erosion seems more likely in men with a history of RRP [13,14]. Delayed erosion of reservoirs into the bladder has occurred as late as 4 years following IPP placement [15]. Inadvertent placement of reservoir into the bladder at the time of surgery is another complication that has been reported with retropubic placement [19].…”

Section: Discussionmentioning

confidence: 99%

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

Stember

Garber

Perito³

2014

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.

“…Certain predisposing conditions are believed to increase the risk of reservoir erosion, including prior pelvic surgery or radiation. In addition to our case I, there are 17 other cases of reservoir erosion into the bladder that have been published over the past 25 years occurring acutely or remotely after implantation [14][15][16][17][18][19][20][21][22][23]. As an example of a recognized acute bladder laceration, Eldefrawy and Kava presented a 67-year-old man status post radical prostatectomy who underwent placement of an IPP via a transscrotal incision.…”

Section: Erosion Into Visceral Structuresmentioning

confidence: 98%

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

Levine¹,

Hoeh²

2012

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.