Abstract Introduction There are three strategies for managing an implanted urologic reservoir during inflatable penile prothesis (IPP) revision. The original reservoir can be removed, deactivated and left in place (drain and retain), or validated and reconnected to an IPP system (reservoir recycling). Although complete removal of a reservoir would prevent the potential complications of a retained device, the formation of a surrounding fibrotic capsule leads to complete removal being less popular among providers compared to drain and retain or reservoir recycling. We sought to evaluate the long-term complications and efficacy of these approaches. Objective To compare the efficacy and safety of the drain and retain and reservoir recycle approaches to IPP revision against the gold standard of full device replacement. Methods We performed a retrospective chart review of our large, single-surgeon tertiary referral center penile prosthesis database between 2007-2022 to identify all individuals with a retained or recycled reservoir. Only those who had undergone appropriate follow-up and had complete documentation about reservoir handling were included in the study. Reservoir-related complications, mechanical failures, and device infections were compared between the retained, recycled, and full replacement groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were assessed using a Student’s T-test. Results There were 140 patients who met inclusion criteria with 48 retained reservoirs, 30 recycled reservoirs, and 62 full replacements. The average age of a reservoir when it was recycled was 4.3 years. Retained and recycled reservoir groups had similar mean follow-up duration, time to revision, and intraoperative time when compared to the full replacement group (Table). Most reservoirs (91% of retained, 90% of recycled, 90% of full replacement) were implanted using the high submuscular technique. Our institution’s virgin IPP implant infection rate was 2.6%. When compared to the full replacement group, infection, mechanical failure, and revision rates were similar for both the retained and recycled reservoir groups (Table and Figure). There was only one verified post-revision reservoir leakage from a recycled reservoir, but no instances of reservoir herniation or reservoir-related bowel complications between the three groups. Conclusions There was no difference in reservoir-related complications, mechanical failure, or infections when comparing the drain and retain or reservoir recycle groups to the full replacement group. Reservoir drain and retain and recycling are both safe and effective management options in IPP revision surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
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