Presentation Authors: Samuel Aly*, Newark , NJ, Jonathan Clavell, Run Wang, Houston, TX, Hossein Sadeghi-Nejad, Newark , NJ
Introduction: Infection of a three-piece inflatable penile prosthesis (IPP) is a rare but serious complication which can be particularly challenging. When removing a 3-piece IPP for infection or malfunction, the cylinders and scrotal pump are easily accessible. However, removal of the reservoir component can be technically challenging because of its difficult locations either deep in the pelvis or high in the abdominal wall, particularly when attempting to remove all the components through a single incision. In this abstract, we describe our approach utilizing an open technique for safe removal of a reservoir located either in the space of Retzius (SOR) or an alternative/ectopic space through the original penoscrotal incision using a lighted retractor and precise dissection with Bovie electrocautery
Methods: We describe our preferred method for removal of prosthetic reservoir and present a retrospective review of patient outcomes after reservoir removal. Primary outcomes included immediate or late complications. Secondary outcomes included operative time.
Results: Thirty-four patients underwent reservoir removal with the use of our described technique. Twenty-three patients (67.6%) had reservoirs removed secondary to device malfunction and 11 (32.4%) secondary to infection. A total of 18 reservoirs (52.9%) were found in the SOR while the other 16 (47.1%) were in an alternative/ectopic space. Two cases (5.9%) required a counter-incision in order to remove the reservoir. Mean overall operative time was 96.2 mins (range 35â€“175). There were no complications in the current series. There was no statistical difference in operative time between reservoirs removed secondary to malfunction when compared to infection (p=0.283). However, there was a difference in operative time between reservoirs removed from the SOR when compared to those removed from an ectopic space, with mean OR times of 104.5 and 75.4 mins, respectively (p=0.001).
Conclusions: Although removal of a reservoir deep in the SOR or placed in alternate/ectopic locations can be challenging, the use of a lighted retractor, meticulous dissection, and a few technical maneuvers described allow for safe removal of the reservoir completely intact while avoiding complications. Our technique for a secondary incision in particularly difficult cases is also described.