Intravesical reservoir erosion as a late complication of a 3-piece inflatable penile prosthesis: ectopic placement in a high-subrectus space: a rare case report

Background: Inflatable penile prosthesis (IPP) is the mainstream treatment of refractory erectile dysfunction (ED). Usually, Space of Retzius (SOR) is the usual IPP reservoir placement space, however, more concerns regarding this space complication have emerged due to its anatomical proximity to some major structures. Intravesical reservoir erosion is the most common reported reservoir complication. Hematuria is the main presentation, sometimes, dysuria and urinary tract infection take place. We present a case of late intravesical reservoir erosion after 3 years of IPP implantation. Methods: Revision surgery was made including placement of AMS Conceal® reservoir in an ectopic high-subrectus space and anterior to transversalis fascia, contralaterally. Results: Recently, ectopic placement has gained popularity among implanters due to its safety and efficacy. Specifically, submuscular space placement, after inventing the lock-out valve to avoid undesirable auto-inflation due to the high back-pressure. Conclusion: Ectopic placement utilizes more choices in cases like hostile pelvis for implanting a 3-piece IPP instead of a malleable prosthesis. Ectopic placement is safe and highly acceptable between high-volume implanters, which may prime a new era of reservoir placement.

penile prosthesis; erectile dysfunction; erosion; bladder; ectopic

[1] Hakky T, Lentz A, Sadeghi-Nejad H, Khera M. The Evolution of the Inflatable Penile Prosthesis Reservoir and Surgical Place-ment. The Journal of Sexual Medicine. 2015; 12: 464–467.

[2] Grimberg D, Wang S, Carlos E, Nosé B, Harper S, Lentz AC. Counter incision is a safe and effective method for alternative reservoir placement during inflatable penile prosthesis surgery. Translational Andrology and Urology. 2020; 9: 2688–2696.

[3] Van Dyke M, Baumgarten AS, Ortiz N, Hudak SJ, Morey AF. State of the Reservoir: Current Concepts of Penile Implant Reservoir Placement and Potential Complications. Current Urol-ogy Reports. 2021; 22: 1–6.

[4] Mykoniatis I, Osmonov D, van Renterghem K. A Modified Sur-gical Technique for Reservoir Placement during Inflatable Pe-nile Prosthesis Implantation. Sexual Medicine. 2020; 8: 378–382.

[5] Simon R, Hakky TS, Henry G, Perito P, Martinez D, Parker J, et al. Tips and tricks of inflatable penile prosthesis reservoir place-ment: a case presentation and discussion. The Journal of Sexual Medicine. 2014; 11: 1325–1333.

[6] Perito PE, Wilson SK. Traditional (retroperitoneal) and abdom-inal wall (ectopic) reservoir placement. The Journal of Sexual Medicine. 2011; 8: 656–659.

[7] Perito P, Wilson S. The History of Nontraditional or Ectopic Placement of Reservoirs in Prosthetic Urology. Sexual Medicine Reviews. 2016; 4: 190–193.

[8] Wilson SK, Henry GD, Delk JR, Cleves MA. The Mentor Alpha 1 Penile Prosthesis with Reservoir Lock-out Valve: Effective Prevention of Auto-inflation with Improved Capability for Ec-topic Reservoir Placement. The Journal of Urology. 2002; 168: 1475–1478.

[9] Stember DS, Garber BB, Perito PE. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius.The Journal of Sexual Medicine. 2014; 11: 605–612.

[10] Manfredi C, Fortier É, Faix A, et al. Penile Implant Surgery Sat-isfaction Assessment. The Journal of Sexual Medicine, 2021, 18: 868–874.

[11] Talib R, Alnadhari I, Canguven O, Yassin A, Shamsodini A, Al-rumaihi K, et al. HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction. Andrologia. 2021; e14132.

[12] Jairam A, Kachhela R, Mukherjee D, Hooda AK. Urinary ascites after an alcohol binge: an uncommon treatable cause of acute kidney injury. Indian Journal of Nephrology. 2014; 24: 255–256.

[13] Baumgarten AS, Kavoussi M, VanDyke ME, Ortiz NM, Khouri RK, Ward EE, et al. Avoiding deep pelvic complications using a ‘Five‐Step’ technique for high submuscular placement of inflat-able penile prosthesis reservoirs. BJU International. 2020; 126: 457–463.

[14] Ziegelmann MJ, Viers BR, Lomas DJ, Westerman ME, Trost LW. Ectopic Penile Prosthesis Reservoir Placement: an Anatomic Cadaver Model of the High Submuscular Technique. The Journal of Sexual Medicine. 2016; 13: 1425–1431.

[15] Loh-Doyle J, Patil MB, Sawkar H, Wayne K, Boyd SD. 3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Out-comes. The Journal of Sexual Medicine. 2018; 15: 907–913.

[16] Osmonov D, Chomicz A, Tropmann-Frick M, Arndt KM, Jüne-mann KP. High-submuscular vs. space of Retzius reservoir placement during implantation of inflatable penile implants. In-ternational Journal of Impotence Research. 2020; 32: 18–23.

[17] Natali A, Grisanti Caroassai S, Tasso G, Cito G, Gemma L, Cocci A, et al. Intra-peritoneal versus retropubic implan-tation of three-piece inflatable penile prosthesis: Patient-reported outcomes and complications. Urologia Journal. 2020; 0391560320967876.