336 Reservoir Induced Bladder Rupture: A Rare Complication of Inflatable Penile Prosthesis Revision Surgery

Abstract

Bladder rupture is a rare complication following prosthesis component replacement for malfunction. Current practice for a deflated reservoir involves overdistention of the reservoir during revision surgery, which can increase the risk of this complication. There is limited literature describing this complication or providing recommendations regarding intraoperative or postoperative management. Our objective is to describe our experiences with this rare complication and propose ways to manage and possibly avoid this complication. We retrospectively reviewed the charts of two patients who underwent inflatable penile prosthesis (IPP) revision surgery complicated by bladder rupture. Intraoperatively, the existing reservoirs had been left in situ and overdistended to break the surrounding fibrous capsule according to common practice prior to being placed in circuit with new cylinders and pump. Gross hematuria was noted in each case following this technique. Delayed identification of the complication occurred in the first case, while the complication was immediately recognized in the second case. The first patient returned to the OR for complete penile prosthesis removal and replacement of component parts including placement of an ectopic reservoir and foley catheter. He subsequently underwent bladder closure for a persistent bladder leak. The second patient underwent immediate removal of three-piece penile prosthesis and placement of a malleable prosthesis and foley catheter. Follow-up cystogram demonstrated the bladder had completely healed with conservative management alone. On follow-up, both patients were satisfied with their penile prostheses and able to engage in penetrative intercourse. Immediate intervention following identification of this complication was crucial to the successful outcomes. In retrospect, this complication may have been minimized if the reservoirs were refilled, but not overdistended. Any back pressure may signify the fibrous capsule has become too thickened and may perforate the bladder if broken. Alternative reservoir placement or placement of a malleable prosthesis may be safer options in this scenario.