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Also known as
Reservoir herniation, IPP reservoir migration, penile prosthesis reservoir herniation, inguinal hernia post-IPP, reservoir displacement
Definition
Inguinal hernia as an IPP complication refers to the protrusion of abdominal contents (such as omental fat, bowel, or the reservoir itself) through the inguinal region related to the placement of an inflatable penile prosthesis reservoir.¹ This rare complication occurs when the reservoir migrates from its intended position in the space of Retzius into the inguinal canal or hernia sac, often due to weakening of the inguinal floor during surgical dissection or increased intra-abdominal pressure.² The condition may present immediately after surgery or develop later, potentially leading to reservoir malfunction, pain, and in severe cases, incarceration with risk of strangulation and necrosis of abdominal organs.³
Clinical Context
Inguinal hernia as an IPP complication is clinically relevant in patients undergoing inflatable penile prosthesis implantation for erectile dysfunction.¹ The traditional approach involves placing the reservoir in the space of Retzius through a transinguinal technique, which may predispose to this complication.⁴ Risk factors include previous pelvic surgery, obesity, chronic coughing, and straining.² Diagnosis is confirmed through physical examination and imaging studies (CT scan or ultrasound).¹ Treatment requires surgical repair through an inguinal incision to remove the reservoir from the hernia sac, repair the hernia (often with mesh), and reposition the reservoir.³ Alternative placement techniques have been developed to prevent this complication, including high submuscular (HSM) placement and counter-incision approaches, which have shown lower rates of reservoir-related complications.⁴ The counter-incision HSM approach virtually eliminates the risk of reservoir herniation by allowing direct visualization of the transversalis fascia.⁴