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

• Published in: International journal of impotence research Vol. 29; no. 5; pp. 215 - 218
• Main Authors: Gross, M S, Stember, D S, Garber, B B, Perito, P E
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2017; Nature Publishing Group
• Subjects: 692/698/1864; 692/699/2768/1575; 692/700/565/545; Abdomen; Abdominal muscles; Abdominal Wall - surgery; Aged; Analysis; Body Mass Index; Care and treatment; Complications and side effects; Erectile dysfunction; Erectile Dysfunction - etiology; Erectile Dysfunction - surgery; Health aspects; Health risk assessment; Humans; Impotence; Male; Medicine; Medicine & Public Health; original-article; Penile Implantation - adverse effects; Penile Implantation - methods; Penile prostheses; Penile Prosthesis; Peritoneum; Peritoneum - surgery; Prostheses; Prosthesis Design; Reproductive Medicine; Retrospective Studies; Risk Factors; rology; Smokers; Urological surgery; Urology
• ISSN: 0955-9930; 1476-5489
• DOI: 10.1038/ijir.2017.26

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/m 2 ), 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.