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A Retrospective Analysis of Risk Factors for IPP Reservoir Entry Into the Peritoneum After Posterior to Transversalis Fascia Placement
Martin S. Gross, MD1, Bruce B. Garber, MD2, Doron S. Stember, MD3, Paul E. Perito, MD4.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Lebanon, NH, USA, 2Hahnemann University Hospital, Philadelphia, PA, USA, 3Mount Sinai Hospital, New York City, NY, USA, 4Perito Urology, Coral Gables, FL, USA.
BACKGROUND: Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with erectile dysfunction (ED) refractory to medical management. We have previously demonstrated a protocol for alternative IPP reservoir placement posterior to the abdominal wall musculature, which was shown to be a safe location with extremely low complication rates. This is in contrast to traditional placement in the retropubic space of Retzius, which can result in bowel, bladder and vascular injury. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after placement posterior to the abdominal wall musculature to further increase the safety of this approach.
METHODS: We retrospectively reviewed our patients with peritoneal entry of the reservoir after posterior to transversalis fascia (PTF) placement during virgin IPP cases performed by a single surgeon. 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. We reviewed preoperative patient health characteristics, history of prior pelvic surgery, intraoperative documentation, postoperative follow-up, complication presentation, and imaging for this group. Follow-up visit data was available for up to 24 months after surgery at regular intervals. We were further able to assess long-term outcomes from this complication, including resolution of peritoneal reservoir entry and eventual IPP replacement.
RESULTS: Peritoneal reservoir entry was identified in two patients out of a total of 2,687. These patients had met the previous criteria. They were distinct in that they were noted to be thin (mean BMI 18.5) current or former smokers, without peritoneal surgical histories. Peritoneal entry was identified early after reservoir placement. Neither patient suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up.
CONCLUSIONS: PTF reservoir placement is a safe, simple and effective method of avoiding vascular and bladder injury during IPP implantation. Peritoneal entry of the reservoir occurs very rarely, and in our series occurred in two patients with distinct physical and pathological features. We recommend early identification of similar patients, with anterior to transversalis fascia placement to prevent peritoneal entry.
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