Current Opinions on Alternative Reservoir Placement for Inflatable Penile Prosthesis among Members of the Sexual Medicine Society of North America

Abstract

Introduction The Sexual Medicine Society of North America (SMSNA) includes as its members the most experienced prosthetic surgeons in North America who implant inflatable penile prostheses (IPPs). Obliteration of the space of Retzius (SOR) resulting from robotic-assisted laparoscopic prostatectomy (RALP) is a growing concern that has prompted many surgeons to look for alternative locations for reservoir placement during IPP implantation. Aim The aim of this article is to educate the community of prosthetic urologists about potential complications and alternative locations for IPP reservoir placement. Methods A panel of high-volume experienced prosthetic surgeons discussed their views on alternative IPP reservoir implantation during a symposium focused on this topic. After reviewing reservoir complications, physician members of the SMSNA in attendance were surveyed using an audience response system (ARS) to facilitate sharing of knowledge, opinions, and recommendations related to reservoir implantation. Main Outcome Measures Six ARS questions were used to identify the percentages of SMSNA member physicians with concerns about traditional IPP reservoir placement and utilizing alternative reservoir placement (ARP), and the impact of changing practice patterns on patient safety. Results A majority (81%) of experienced implant surgeons surveyed think that RALP sometimes or frequently makes traditional IPP reservoir placement more difficult. Placement of the reservoir in an alternative location is sometimes or frequently advantageous for patient safety. A vast majority (97%) of the 95 respondents indicated that ARP techniques should be included in physician training courses. Conclusions Physicians have concerns about reservoir placement in the SOR in RALP patients, which may explain why ARP is popular among SMSNA members. Device manufacturers should support physician training that provides for ARP. Clinical outcomes in RALP patients are needed to better understand the risks and benefits, and define the ideal location of reservoir placement in this population.

A Guide for Inflatable Penile Prosthesis Reservoir Placement: Pertinent Anatomical Measurements of the Retropubic Space

“…The increasing popularity of robotic‐assisted laparoscopic prostatectomy (RALP) has added additional challenges to placing a reservoir in the SOR because the space becomes obliterated with this technique [17]. A recent study has shown that 82% of experienced implant surgeons feel that placing a reservoir in the SOR in RALP patients is more difficult [18]. These recent concerns of reservoir placement in the SOR, particularly in RALP patients, have fueled the recent interest in alternative reservoir placement sites.…”

A review of surgical strategies for penile prosthesis implantation in patients with Peyronie’s disease

“…Traditionally, the reservoir has been placed in the prevesical or retropubic space, also known as the space of Retzius. Although complications are rare, risk of viscous or vascular injury has led some prosthetic surgeons to believe placement in an “ectopic” location, such as anterior or posterior to the transversalis fascia, is advantageous to patient safety ( 48 - 50 ).…”

The Evolution of the Inflatable Penile Prosthesis Reservoir and Surgical Placement

“…Participants reported that IPP reservoirs are either sometimes (46%) or frequently (36%) harder to place in the space of Retzius among robotic-assisted laparoscopic prostatectomy patients and that reservoir placement outside of the space of Retzius is sometimes (54%) or frequently (35%) advantageous for patients' safety. Respondents agreed (97%) that physician-training courses should specifically include content relating to alternative reservoir placement techniques [10].…”