The Evolution of the Inflatable Penile Prosthesis Reservoir and Surgical Placement

Abstract

The traditional inflatable penile prosthesis (IPP) reservoir placement is below the transversalis fascia in the space of Retzius. In 2002, Dr. Steve Wilson described ectopic reservoir placement, thereby providing a safe and effective alternative for implant surgeons. This new approach obviated the need for a second incision and decreased operative times during surgery. In the manuscript, he also described the introduction of a reservoir lock-out valve, which prevents autoinflation of the penile implant. The development of lockout valves and flat reservoirs has contributed to the early success and feasibility of submuscular placement techniques. Thirteen years after Dr. Wilson’s pivotal study, this technique should be in the armamentarium of all urologic prosthetic surgeons. Accordingly, in certain subsets of patients, ectopic/ submuscular reservoir site placement should be considered a safe, effective alternative to standard reservoir placement in the space of Retzius.

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“…44 However, the addition of the lock-out valve has led to autoinflation rates of less than 2%, and has allowed for the more frequent and successful placement of the reservoir in the ectopic location which is beneficial in patients with an obliterated space of Retzius, as is seen following prostatectomy. 46…”

Açık radikal retropubik prostatektomi sonrası inflatable penil protez rezervuarı, penoskrotal transvers insizyon ile Retzius alanına güvenle yerleştirilebilir

“…[19,20] Buna karşın Marlex mesh ile bilateral herni onarımı, sistektomi, mesane augmentasyonu, laparoskopik radikal prostatektomi ve aorto-femoral baypas gibi perivezikal fibrozise yol açan cerrahilerden sonra rezervuarların giriş yolundan bağımsız olarak Retzius alanına yerleştirilmesi komplikasyonlara yol açabilir. [18,21] Rezervuar için fibrotik Retzius alanı hazırlanırken ve implantasyondan sonra ortaya çıkabilecek vasküler, bağırsak ve mesane komplikasyonlarından kaçınmak için karın ön duvarında rektus kası altına ve transvers fasyanın üstüne rezervuarların ektopik yerleştirilmesi popülerlik kazanmıştır.…”

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“…Drawbacks to the ectopic location, however, include an increased likelihood of palpation in the abdominal wall and of cylinder autoinflation due to increased pressure around the reservoir. Device improvements by both IPP manufacturers, Boston Scientific and Coloplast, have minimized these downsides with the advent of low profile reservoirs and fluid lock-out valves ( 25 ). Reservoir palpability was noted in only 3.4% of 2,687 patients, and autoinflation occurred in only 0.09% of patients in the same series of ectopic submuscular placement reviewed by Stembler et al ( 26 ).…”

“…Patient self-reported satisfaction with IPP following the high submuscular approach for reservoir placement was 96% in a series of 96 patients ( 28 ). Based on such data, the United States Food and Drug Administration approved the ectopic placement of the Coloplast IPP reservoir in 2015 ( 25 ).…”