Reservoir Repositioning and Successful Thrombectomy for Deep Venous Thrombosis Secondary to Compression of Pelvic Veins by an Inflatable Penile Prosthesis Reservoir

Abstract

Introduction We describe a 51-year-old man with a history of radiation therapy and large bowel diversion for rectal cancer who underwent an uneventful penile implant surgery for erectile dysfunction that was refractory to conservative therapy. The patient presented with acute left lower extremity swelling and pain a few days after surgery. Workup revealed compression of the pelvic veins by the prosthesis reservoir. Aim To highlight an avoidable, adverse event related to penile prosthesis reservoirs. Methods Retrospective review of a clinical case. Results The patient underwent repositioning of the reservoir followed by venous thrombectomy and Greenfield filter placement. Conclusion To the best of our knowledge, this is the first report of an early diagnosis and successful thrombectomy of the external iliac and common femoral vein thrombosis secondary to reservoir compression. Awareness of this possible adverse event and the management strategy are helpful to surgeons who perform penile prosthesis surgery.

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

“…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 [34–37]. Brison et al.…”

“…Repeat ultrasound showed that a deep vein thrombosis had developed, resulting in subsequent venous thrombectomy with inferior vena cava filter placement. This complication was attributed to lateral displacement of the reservoir secondary to severe scarring from the previous pelvic surgery and radiation [34]. Other cases are outlined in Table 2.…”

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

“…Compression of the external iliac vein was also a frequently reported complication noted in 5/37 (14%) cases [23,25,26,29,30]. The most common symptom noted was lower extremity edema in 5/5 cases.…”

Venous Thromboembolism Secondary to Penile Prosthesis

“…4 A separate suprapubic incision can be made to reduce the risk of vascular compression, which should be considered in patients at high risk of migration. 2 Complication rates differ between the available types of prosthesis, 5 but incidence of venous thrombosis secondary to these devices is so rare that differences in VTE risk is not known.…”

“…4 Adhesion formation secondary to previous radiotherapy or surgical intervention has been reported to predispose to reservoir migration, causing compression of local vasculature. 2,4 Penile prosthesis reservoirs range in size from 65 to 100 mL and are placed blindly into the retropubic space through a penoscrotal incision, via the external inguinal ring. 4 A separate suprapubic incision can be made to reduce the risk of vascular compression, which should be considered in patients at high risk of migration.…”