Inflatable Penile Prosthesis Reservoir Placement Research Articles

(022) Penile Implant Reservoir Placement: The Current Utilized Various Techniques and the Associated Outcome: Systematic Review and Meta-Analysis

Abstract Introduction Many innovations in the field of inflatable penile prosthesis (IPP) has been emerged. Since the introduction of the IPP, reservoir positioning in the space of Retzius (SOR) was considered the classical approach that had been utilized for many years. However, in certain group of patients, reservoir insertion in such space might be difficult or even risky. As a result, many alternatives for the reservoir placement outside the SOR has emerged with the intent of safe and reliable reservoir placement. Objective To conduct a systematic review for the studies evaluating the outcomes of different techniques used for IPP reservoir placement to look for possible superiority of any approach over others. Methods A systemic review was performed utilizing (PRISMA) statement. The PubMed and Google scholar were used to look for articles published up to January 2023. Original articles reporting different techniques for IPP reservoir placement and evaluating the associated outcomes were included. Data regarding study design, sample size, approach of reservoir placement, surgical technique, device type and reported outcomes (infection rate, bladder/bowel/vascular injury, reservoir herniation, mechanical failure, auto-inflation, reservoir palpability and patients’ satisfaction) were collected. Pooled proportion was calculated and included in the meta-analysis. The Newcastle-Ottawa scale was used for assessing the quality of the studies. Results A total of 23 articles meeting the inclusion criteria, all were retrospective reviews. 11 compared more than one technique for reservoir placement whereas 12 described a single technique. In total, techniques for 6 main different reservoir locations has been reported, including SOR (7 studies), submuscular/subrectus (6 studies), Lateral retroperitoneal (1 study), subcutaneous (1 study), sub external oblique (1 study) and intraperitoneal (1 study). Another 7 modifications have been described for the SOR technique (traditional SOR, accessing SOR using blunt scissor in post-prostatectomy patients, accessing SOR using blunt scissor in virgin cases, dilating SOR using catheter balloon, accessing SOR under direct vision, accessing SOR through external oblique fascia incision, and the addition of The Tubing Hitch&Lasso, Intussusception Anchor technique (THALIA)). Another 6 modifications for the submuscular/subrectus approach have been described (posterior to transversalis fascia (PTF), anterior to transversalis fascia (ATF), high submuscular, subrectus using counter incision, subrectus with the addition of THALIA, low submuscular with trans-fascial-fixation (TFF)). None of the studies have proven the superiority of one technique over others, with most of the techniques has comparable intra-operative and post-operative outcomes (table 1). The addition of anchoring step (THALIA or TFF) resulted in neglected risk of reservoir herniation, however, related studies has small sample size with no comparison groups. Meta-analysis for the studies of SOR (n=7) and submuscular/subrectus (n=6) groups showed a statistically significant difference only in the herniation rates (figure 1). 10 studies were of strong quality (8 stars) while the remaining 13 studies were of poor quality. Conclusions Modest evidence suggests a comparable favorable outcome of various approaches used for IPP reservoir placement. The lack of enough prospective trials, short term follow up, and diversity in the techniques prescribed prevent the ability to build strong evidence. For the purpose of supporting the superiority of any technique, further prospective studies on a larger number of patients with long-term follow up are needed to reach a solid verdict. Disclosure No.

(394) Penile Implant Reservoir Placement: The Current Utilized Various Techniques and the Associated Outcomes: Systematic Review and Meta-analysis

Abstract Introduction Many innovations in the field of inflatable penile prosthesis (IPP) has been emerged. Since the introduction of the IPP, reservoir positioning in the space of Retzius (SOR) was considered the classical approach that had been utilized for many years. However, in certain group of patients, reservoir insertion in such space might be difficult or even risky. As a result, many alternatives for the reservoir placement outside the SOR has emerged with the intent of safe and reliable reservoir placement. Objective To conduct a systematic review for the studies evaluating the outcomes of different techniques used for IPP reservoir placement to look for possible superiority of any approach over others. Methods A systemic review was performed utilizing (PRISMA) statement. The PubMed and Google scholar were used to look for articles published up to January 2023. Original articles reporting different techniques for IPP reservoir placement and evaluating the associated outcomes were included. Data regarding study design, sample size, approach of reservoir placement, surgical technique, device type and reported outcomes (infection rate, bladder/bowel/vascular injury, reservoir herniation, mechanical failure, auto-inflation, reservoir palpability and patients’ satisfaction) were collected. Pooled proportion was calculated and included in the meta-analysis. The Newcastle-Ottawa scale was used for assessing the quality of the studies. Results A total of 23 articles meeting the inclusion criteria, all were retrospective reviews. 11 compared more than one technique for reservoir placement whereas 12 described a single technique. In total, techniques for 6 main different reservoir locations has been reported, including SOR (7 studies), submuscular/subrectus (6 studies), Lateral retroperitoneal (1 study), subcutaneous (1 study), sub external oblique (1 study) and intraperitoneal (1 study). Another 7 modifications have been described for the SOR technique (traditional SOR, accessing SOR using blunt scissor in post-prostatectomy patients, accessing SOR using blunt scissor in virgin cases, dilating SOR using catheter balloon, accessing SOR under direct vision, accessing SOR through external oblique fascia incision, and the addition of The Tubing Hitch&Lasso, Intussusception Anchor technique (THALIA)). Another 6 modifications for the submuscular/subrectus approach have been described (posterior to transversalis fascia (PTF), anterior to transversalis fascia (ATF), high submuscular, subrectus using counter incision, subrectus with the addition of THALIA, low submuscular with trans-fascial-fixation (TFF)). None of the studies have proven the superiority of one technique over others, with most of the techniques has comparable intra-operative and post-operative outcomes (table 1). The addition of anchoring step (THALIA or TFF) resulted in neglected risk of reservoir herniation, however, related studies has small sample size with no comparison groups. Meta-analysis for the studies of SOR(n=7) and submuscular/subrectus(n=6) groups showed a statistically significant difference only in the herniation rates (figure 1). 10 studies were of strong quality (8 stars) while the remaining 13 studies were of poor quality. Conclusions Modest evidence suggests a comparable favorable outcome of various approaches used for IPP reservoir placement. The lack of enough prospective trials, short term follow up, and diversity in the techniques prescribed prevent the ability to build strong evidence. For the purpose of supporting the superiority of any technique, further prospective studies on a larger number of patients with long-term follow up are needed to reach a solid verdict. Disclosure No.

(471) The Transfacial Fixation of an Ectopic Low Submuscular Reservoir: A Novel Approach to Inflatable Penile Prosthesis Reservoir Placement

Abstract Introduction Ectopic reservoir placement has become a more routine practice among high-volume penile prosthesis implanters. In particular, the low submuscular approach has gained considerable popularity given its safe location away from structures of concern such as the iliac vein or bowel, which can frequently be in the proximity of reservoirs placed in the traditional Space of Retzius position in patients with prior pelvic procedures such as a radical prostatectomy. However, the low submuscular approach is not without its own risks, most notably, herniation of the reservoir to an unintended location. In order to maximize the benefits of submuscular reservoir placement and minimize risk for herniation, we describe a novel approach to low submuscular reservoir placement. Objective The objective of this study is to present outcomes data on inflatable penile prosthesis patients who underwent low submuscular (LSM) reservoir placement with transfascial fixation (TFF). Methods A retrospective review was conducted on patients who underwent an IPP placement using the LSM with TFF technique between June 2019 and March 2022 by a single, high-volume surgeon at a tertiary medical center. Preoperative patient characteristics were collected, and patients then conducted a telephone interview with a modified questionnaire to assess satisfaction with the IPP and reservoir concealment. Results A total of 34 patients underwent IPP surgery with low submuscular reservoir placement with TFF of which 29 completed the questionnaire (85.2%). The average age of patients was 68.3 years, and 61.5% of patients had undergone a radical prostatectomy. Overall satisfaction with the penile implant was 4.1 (out of 5). Eight patients (26%) were able to palpate the reservoir, and four patients (15.4%) were able to visualize the reservoir impression below the abdominal skin. However, overall satisfaction with reservoir concealment was 4.6 (out of 5) (Table 1). No surgical revisions were required and there were no surgical complications such as bowel obstruction, herniations, bladder erosion, or vascular injuries. Conclusions Low submuscular IPP reservoir placement with TFF is an alternative approach for reservoir placement with a high degree of patient satisfaction, decreased risk for reservoir herniation, and significant ease of placement compared to alternative methods in the literature. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Inflatable penile prosthesis reservoir placement—Are we ready for a paradigm change?

In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.

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.

Distance From Critical Pelvic Structures: Radiographic Comparison of High Submuscular and Space of Retzius IPP Reservoir Placement Techniques

ObjectiveTo evaluate the distance from critical pelvic structures (CPS, defined as bladder and iliac vessels) among inflatable penile prosthesis (IPP) reservoirs placed into the space of Retzius (SOR) and high submuscular (HSM) locations using cross-sectional imaging. IPP reservoir placement into the HSM location has been proposed as a strategy to prevent injury due to greater distance from CPS. MethodsOur institutional database was retrospectively reviewed to identify men who underwent IPP insertion between 2007 and 2020 and had available cross-sectional abdominopelvic imaging after the time of surgery. Patients were grouped based on reservoir placement technique (SOR vs. HSM). Staff radiologists blinded to placement technique evaluated reservoir position to determine the shortest distance between CPS and the reservoir and if a mass effect was present on CPS. Variables were analyzed using chi-squared, Fisher's exact, and student's T-tests as indicated. ResultsAmong 1,010 IPP cases performed during the study interval, 139 (13%) were imaged. Compared with SOR reservoirs (n = 32), HSM reservoirs (n =107) were significantly less likely to induce a mass effect on the bladder (72 vs. 9%, P = <.01) or iliac vessels (34 vs. 4%, P = <.01) and were located roughly 5 times further from the bladder (10 ± 22 vs. 49 ± 36 mm, P = <.01) and iliac vessels (5 ± 9 vs. 23 ± 26 mm, P = <.01). ConclusionThis study radiographically confirms that IPP reservoirs are located significantly further away from CPS following HSM placement compared to SOR placement.

State of the Reservoir: Current Concepts of Penile Implant Reservoir Placement and Potential Complications.

To discuss mechanical and surgical innovations in inflatable penile prosthesis (IPP) surgery and their implications on reservoir placement and patient outcomes. The past decade has seen a new emphasis on optimizing outcomes and minimizing complications associated with IPP reservoirs. Innovations in device design have accordingly yielded safer, more durable IPP outcomes over the past four decades. Modifications in surgical approach for reservoir placement abound for both traditional space of Retzius and ectopic reservoir placement techniques. Surgical and medical history, patient anatomy, and patient preference should all be considered when choosing approach for IPP reservoir placement. Prosthetic urologists should be proficient in multiple approaches to provide the best care to their patients.

Avoiding deep pelvic complications using a 'Five-Step' technique for high submuscular placement of inflatable penile prosthesis reservoirs.

To compare our extended experience with high submuscular (HSM) reservoir placement to traditional space of Retzius (SOR) placement and to present our current, refined 'Five-Step' technique (FST) for HSM placement. Data were retrospectively collected on patients undergoing inflatable penile prosthesis (IPP) placement between January 2009 and June 2019. Re-operative cases were excluded. Reservoir-related complications and subsequent revisions were compared between SOR (2009-2012) and HSM reservoir groups (2012-2019). HSM patients were subdivided into two cohorts: 'Initial Technique' (2012-2014) and FST (2014-2019). The refined FST protocol was developed in 2014 to optimise outcomes and includes the following steps: (i) Position and Access; (ii) Develop Lower HSM Pocket; (iii) Develop Upper HSM Pocket; (iv) Reservoir Delivery (fill and fine-tune); (v) Confirm and Connect. Between January 2009 and June 2019, 733 total IPP procedures (586 HSM, 147 SOR) were performed by a single surgeon at our institution, 561 of which were virgin cases (430 HSM, 131 SOR) and included in this analysis. Overall, surgical revision was required in 10/430 (2.3%) HSM cases (one delayed bowel obstruction, nine herniations) and six of 131 (4.6%) SOR cases (one bladder erosion, two vascular injuries, and three herniations, P=0.22). When comparing the FST to the Initial Technique, we noted a significant decrease in complications requiring surgical revision (P=0.01). Among 133 cases performed with the Initial Technique, seven (5.3%) required surgical revision (one bowel obstruction after placement into the peritoneal cavity, six herniations). Among 297 FST cases, three (1.0%) required revision, all due to herniation. HSM placement of IPP reservoirs is a safe alternative to traditional SOR placement. Major deep pelvic reservoir complications were minimised using our current refined FST.

Reservoir Placement Considerations During Inflatable Penile Prosthesis Surgery.

To discuss emerging alternative strategies for reservoir placement during inflatable penile prosthesis surgery. Innovations in penile prosthesis design have facilitated the development of various alternative approaches for reservoir placement. Avoiding the space of Retzius is particularly appealing in patients with a history of pelvic surgery and/or radiation. The high submuscular technique utilizes a low-profile reservoir in combination with the implant's lockout valve to allow for safe placement in the potential space between the anterior abdominal wall musculature and the transversalis fascia, far cephalad from the external inguinal ring and without the need for a counter-incision. Multiple recent publications have demonstrated the safety and efficacy of the high submuscular technique. High submuscular inflatable penile prosthesis reservoir placement is a safe and effective alternative to placement within the space of Retzius.

AB022. New strategy for inflatable penile prosthesis reservoir placement and removal

Inflatable penile prostheses (IPP) have been utilized reliably as a definitive treatment for medically refractory erectile dysfunction (ED) over the last four decades. The device consists of two intra-corporal penile cylinders, a pump placed in the scrotum, and a fluid-containing reservoir. However, placement of an IPP reservoir in a patient with multiple lower abdominal/pelvic surgeries is technique challenge. The Conceal low profile reservoir and Cloverleaf are designs to allow ectopic placement and to avoid potential bladder, bowel or vascular injury. Another rare but potentially devastating complication of IPP implantation is infection of the implant. In the event that an implant becomes infected, all components of the IPP need to be removed. Removal of reservoir has also been surgically challenging due to its location; either deep in the space of Retzius of the pelvis or high in the abdomen between the muscular fascia. This presentation will discuss new strategy for IPP reservoir placement and removal.

A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement.

Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with ED refractory to medical management. We have previously demonstrated a protocol for IPP reservoir placement within the abdominal wall musculature, which was shown to be a safer location than traditional placement in the retropubic space of Retzius. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after abdominal wall placement of the reservoir. We retrospectively reviewed our two patients with peritoneal entry of the reservoir after posterior to transversalis fascia and anterior to transversalis fascia placement during virgin and compromised IPP cases, respectively. Our goal was to assess common inherent patient and surgical factors that resulted in this complication in order to develop a management algorithm to prevent future occurrence during alternative reservoir placement. Peritoneal reservoir entry was identified in two patients. These patients were both noted to be thin (mean body mass index (BMI) 18.5 kg/m2), current or former smokers. Peritoneal entry was identified early after reservoir placement. Neither of the patients suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up. Peritoneal entry of the reservoir occurs very rarely and, in our series, occurred in a cohort of patients with low BMI and tobacco use history. We recommend early identification of similar patients and subsequent reservoir placement anterior to transversalis fascia with caution to prevent peritoneal entry.

Modified Inflatable Penile Prosthesis Reservoir Placement Into Space of Retzius: Comparing Outcomes in Men With or Without Prior Pelvic Surgery

BackgroundTraditional inflatable penile prosthesis (IPP) reservoir placement has rare but potentially serious complications including damage to local structures, and Levine and Hoeh (J Sex Med 2012;9:2759–2769) described a modified technique designed to avoid these complications. AimTo determine whether the modified Jorgenson scissors technique is safe and effective in patients who have had prior pelvic surgery. MethodsA retrospective chart review was performed on all patients who had a three-piece IPP placed by a single urologist from 2011 to 2015. Complication rates between the prior pelvic surgery group and the virgin pelvis group were compared using χ2 test. Differences between the two groups were considered statistically significant at a P value less than .05. OutcomesReservoir-related complication rate and rate of converting to ectopic placement. ResultsA total of 246 procedures were included, with 174 having no prior pelvic surgery and 72 with prior pelvic surgery. The reservoir-related complication rates were 2.8% (2 of 72) in the prior pelvic surgery group and 3.4% (6 of 174) in the virgin pelvis group. This difference was not statistically significant (P = .79). The two complications from the prior pelvic surgery cohort were inguinal hernias requiring surgical repair, which occurred in the same patient. In the virgin pelvis cohort, there were five inguinal hernias and one autoinflation. There were 16 patients who required ectopic placement of the reservoir owing to difficulty in entering the space of Retzius (SOR), 14 of whom had prior pelvic surgery. Clinical ImplicationsWe believe this modified technique for IPP reservoir placement into the SOR is a safe alternative because the Jorgenson scissors allow perforation into the SOR away from vital structures. Strengths and LimitationsThe study is limited by the fact that it is a retrospective, single-center, chart review of a non-randomized surgical procedure with variable follow-up in a limited number of patients. Its strength is its applicability to provide surgeons a modified technique that can be used routinely for IPP reservoir placement that appears to be safe and effective, even in men who have had prior pelvic surgery. ConclusionIn our experience, the modified Jorgenson scissors technique allows for safe entry into the SOR through a transverse scrotal incision and is a viable alternative to the standard SOR placement and the ectopic approach.Capoccia EM, Phelps JN, Levine LA. Modified Inflatable Penile Prosthesis Reservoir Placement Into Space of Retzius: Comparing Outcomes in Men With or Without Prior Pelvic Surgery. J Sex Med 2017;14:968–973.

Retropubic Dilation With a Foley Catheter Balloon: A Novel Technique for Penile Prosthesis Reservoir Placement

The 3-piece inflatable penile prosthesis was introduced in 1973 as a treatment for men with erectile dysfunction. Consisting of 2 corporal cylinders, 1 pump, and a fluid-filled reservoir, the prosthesis is placed by blunt dissection into the retropubic space. The dissection for the reservoir is performed blindly into a space juxtaposed with nerves, vessels, and the bladder. To propose a novel approach for inflatable penile prosthesis reservoir placement involving gentle dilation of the retropubic space using a Foley catheter balloon. Patient medical records from 1 surgeon were reviewed. Patients did not have a history of pelvic surgery or prostatectomy. Each implant was approached using a penoscrotal incision, and the retropubic space was dilated with a 30-mL Foley catheter balloon filled to 100-mL capacity before reservoir placement. The postoperative visits were examined for complications, including reservoir infection and herniation. A literature search of penile prosthesis reservoir placement technique and complications (eg, herniation, infection) of reservoir placement was also performed. Fifteen patient records were examined. The reservoir herniation rate was 0% and the infection rate was 7%. The average reservoir herniation rate is reported to be 1% to 3%, and the average infection rate is reported to be 1% to 5%. The use of a Foley catheter balloon is a safe, atraumatic, cost-effective, and easily performed method of dilating the retropubic space for subsequent inflatable penile prosthesis reservoir placement.

Corrections to “A Guide for Inflatable Penile Prosthesis Reservoir Placement: Pertinent Anatomical Measurements of the Retropubic Space”

Corrections to “A Guide for Inflatable Penile Prosthesis Reservoir Placement: Pertinent Anatomical Measurements of the Retropubic Space”

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

There have been many advances in the inflatable penile prosthesis (IPP) since the 1970s. While these devices were initially fraught with mechanical malfunction, the most recent models prove to be much more reliable. Although reservoir complications are not common, when they do occur, it typically involves damage to the surrounding tissues. The ability to recognize and treat these complications is paramount for any surgeon that routinely places IPPs. The aim of this article was to present a unique reservoir-related complication as well as perform a literature review of reservoir-related complications and techniques for reservoir placement, and provide a summary of dimensions and technical aspects of commonly used reservoirs. We reviewed a unique reservoir-related complication that presented to our institution with urinary retention and constipation. We also reviewed reservoir-related complications since 1984, reviewed the most recent surgical techniques involved in reservoir placement, and summarized the dimensions and technical characteristics of both the American Medical System and Coloplast reservoirs. A reservoir-related complication that resulted in urinary retention and constipation is the main outcome measure. Although uncommon, reservoir complications do occur. The most common case report complication in the published literature is bladder erosion followed by external iliac compression, ileal conduit erosion, and small bowel obstruction. The case that presented at our institution was the result of a reservoir that was improperly placed in the perineum, causing urinary retention and constipation due to the compression of the bulbar urethra and rectum. In this era, mechanical failures of IPP reservoirs are rare as most complications occur due to damage of the surrounding tissues. Prevention, diagnosis, and treatment of these complications are important for any surgeon that implants IPPs.

Correction to "A guide for inflatable penile prosthesis reservoir placement: Pertinent anatomical measurements of the retropubic space"

Correction to "A guide for inflatable penile prosthesis reservoir placement: Pertinent anatomical measurements of the retropubic space"

1228 MRI ANALYSIS OF ANATOMICAL LANDMARKS WITH RESPECT TO INFLATABLE PENILE PROSTHESIS RESERVOIR PLACEMENT

INTRODUCTION AND OBJECTIVES: Insertion of a threepiece inflatable penile prosthesis (IPP) reservoir is a “blind procedure”. The traditional reservoir placement in the space of Retzius can result in damage to bladder, bowel and femoral blood vessels. A single cadaveric study has delineated pertinent anatomic relationships. We have attempted to evaluate similar anatomical measurements in an in vivo model using magnetic resonance imaging (MRI). METHODS: Endorectal MRI studies in men being evaluated for prostate cancer were reviewed. Prior pelvic surgery, radiation or an in situ urinary catheter were exclusions. Endorectal MRI was performed on a 3 Tesla system with T1 and T2 weighted images reviewed usingboth axial and sagittal planes. Pertinent anatomical landmarks were evaluated by 2 independent readers, blinded to clinical and pathological data. All measurements were defined by an experienced radiologist. Measurements included (i) distance from external inguinal ring(EIR) to external iliac vein(EIV) (ii) superior aspect of pubic symphysis (PS) to bladder and (iii) EIR to nearest bladder point. Correlation was measured between bladder volume and (iii). For distances (i) and (iii) bilateral measurements were obtained and data averaged as no significant differences were observed. Means and standard deviations are presented. Pearson correlations were used to assess the relationship between variables, and regression analysis use to predict changes in (iii) with respect to bladder volume. RESULTS: 24 MRI studies were reviewed. Mean distances: EIR to EIV 3.09cm (2.23-3.84);superior aspect of PS to nearest point of bladder (midline) 0.86cm (0.37-1.24); EIR to the nearest point of the bladder 1.76cm (0.08-3.66). Correlation between EIR-bladder distance and bladder volume was r -0.36, p 0.9. Average bladder volume was 93.04cm3 (34.5-177.6),(SD 36). On regression analysis as bladder volume increases by 10 cm3 the distance to the EIR decreased by 1mm. CONCLUSIONS: This is the first attempt to analyse anatomical landmarks with respect to IPP reservoir placement in an in vivo model. The close proximity of the external iliac vein and bladder should alert surgeons to the potential for damage to these structures during this procedure. This also emphasizes the importance of decompressing the bladder during reservoir placement.