302 Outcomes Related to Penile Prosthesis Reservoir Removal: A Multi-institutional Experience

Abstract

Removal of an inflatable penile prosthesis (IPP) reservoir deep in the space of retzius (SOR) or alternate/ectopic space (AES) can be difficult, even for the experienced surgeon. The purpose of this study was to look at outcomes and complications related to reservoir removal during revision or explant surgery. We retrospectively reviewed databases of 3-piece IPP revision and removal surgeries from 7 high-volume prosthetic surgeons at 6 institutions from January 2011 to December 2018. Concurrent urinary sphincter, sling or Mini-jupette placement were excluded. Outcomes and complications related to IPP reservoirs during revision and removal surgery were analyzed. A total of 171 revisions and 44 explants (215 total cases included) were performed of which 172 reservoirs (80%) were in the SOR and 43 (20%) in an AES. Thirty-five cases were secondary to infection (16.3%), 49 (22.8%) had malposition and 131 (60.9%) were due to malfunction. There were 44 cases (20.5%) during which the reservoir was retained. Reasons for retaining reservoirs included difficult dissection (9.1%), avoid injuring surrounding structures (18.2%), reuse of the reservoir for a new IPP (59.1%), and unspecified (13.6%). Reservoir-related postoperative complications included a delayed infection (n=1) of a retained AES reservoir that developed a cutaneous fistula 4 years after revision surgery. Among removed reservoirs (N=171), 15 (8.8%) required a counter-incision. Reservoir-related intraoperative complications included a bladder perforation (N=1) in the SOR group, and an avulsion of the epigastric vessels requiring abdominal exploration (N=1) in the AES group.