Erosion of Inflatable Penile Prosthesis Reservoir into Neobladder

Abstract

Introduction Erosion of the reservoir into surrounding tissues is a rare complication after inflatable penile prosthesis (IPP) implantation. Aim To present a new case and a review of the literature including discussion of pathogenesis, risk factors, and management options. Methods We present the case of a 75-year-old male who underwent placement of an IPP for postoperative erectile dysfunction with a history of bladder cancer requiring radical cystoprostatectomy and Studer neobladder. Six years after IPP placement, he presented with recurrent febrile urinary tract infection that seemed to be precipitated by cycling of his penile prosthesis. Cystoscopy and cross-sectional computed tomography imaging demonstrated erosion of the inflatable penile prosthesis reservoir into the neobladder. Results Patient underwent open removal of the IPP reservoir and cystorrhaphy with a plan for future prefascial reimplantation of an IPP reservoir. Conclusions In patients with a history of abdomino-pelvic surgery or radiation therapy, the retroperitoneal space may be extremely fibrotic and the transversalis fascia may have thickened. Potential intraoperative complications as well as reservoir erosion may be avoided by using a two-piece device or ectopic reservoir placement. Management options for reservoir erosion include explantation of the entire device as well as reservoir removal with salvage of remaining components.

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

“…Erosion of the reservoir into the ileal conduit/ neobladder was found in 4/37 (11%) cases [11,20,32,33]. Flank pain was present in 2/4 cases, hematuria was present in 1/4 cases, 1/4 cases had the presence of recurrent UTI, and 1/4 cases was asymptomatic.…”

Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon

“…The obliteration of the space of Retzius during these procedures results in an increased risk of intraperitoneal reservoir placement [22,29]. An increased risk of bowel complications has also been reported in the presence of neobladders [30], ileal conduits [21,31], and continent reservoirs [32].…”

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

“…These could erode or perforate the corpora cavernosa or affect the symmetry of the penis (SST effect) (17).…”