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Also known as
Fluid reservoir, penile implant reservoir, IPP reservoir, prosthesis fluid chamber, saline reservoir, inflatable penile prosthesis reservoir (IPPR)
Definition
A reservoir (implant) is a fluid-filled container component of an inflatable penile prosthesis that stores saline solution when the device is in a flaccid state.1 It consists of a polyurethane elastomer shell and silicone elastomer tubing adapter, which are bonded using silicone elastomer adhesive.2 The reservoir is typically implanted in the anterior lateral aspect of the perivesical space behind the rectus abdominis muscle during penile prosthesis surgery.3 It functions as a storage chamber that holds the fluid which is transferred to the inflatable cylinders within the penis during device activation, enabling the patient to achieve an erection.4 When the patient desires detumescence, compression of the release valve allows passive flow of fluid back into the reservoir, returning the penis to its flaccid state.5
Clinical Context
The reservoir component of an inflatable penile prosthesis is clinically relevant in the surgical treatment of erectile dysfunction (ED) that is unresponsive to other forms of treatment.1 Patient selection for this procedure typically includes men with severe ED who have failed or are unsuitable for pharmacological interventions, vacuum erection devices, or other less invasive treatments.2
During preoperative planning, a detailed assessment of the patient’s surgical history is crucial, as major pelvic surgeries like radical prostatectomy, radical cystectomy, colorectal surgery, and renal transplantation may necessitate adjustments to the reservoir placement.3 The abdomen should be evaluated for any surgical incisions that may impact pelvic tissue planes, and radiation tattoos can help identify prior radiotherapy for prostate cancer, which may affect reservoir positioning.4
The surgical implantation of the reservoir is performed under general anesthesia. In a 3-piece inflatable penile prosthesis placement, the surgeon may opt for an infrapubic or penoscrotal approach based on preference and patient anatomy.5 With the infrapubic approach, reservoir placement is done using direct visualization, while the penoscrotal approach requires blind placement of the reservoir in the space of Retzius.6
Postoperatively, patients require education on device operation and management. The reservoir typically holds approximately 65-100 ml of sterile saline solution, depending on the specific device model.7 Complications specifically related to the reservoir component may include auto-inflation, reservoir herniation, erosion into adjacent structures, or fluid leakage.8 Radiologists should be aware that the reservoir can appear as an unexpected finding on imaging studies, potentially mimicking pathological conditions such as abscesses or hematomas in patients who do not disclose their implant history.9