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Also known as
Reservoir migration, IPP reservoir displacement, prosthetic reservoir herniation, penile implant reservoir herniation, inflatable penile prosthesis reservoir extrusion, reservoir protrusion
Definition
Penile prosthesis reservoir herniation is a rare postoperative complication of inflatable penile prosthesis (IPP) surgery in which the fluid reservoir of the device displaces from its intended anatomical position (typically the space of Retzius or submuscular location) and protrudes into the inguinal canal or scrotum.1 This mechanical complication occurs almost exclusively in penoscrotally placed prostheses, with an incidence rate of approximately 0.7%.1 The herniation typically develops in the immediate postoperative period, often triggered by increased intra-abdominal pressure from vigorous coughing, vomiting, or straining.2 The displaced reservoir may cause discomfort, affect device function, and in rare cases lead to more serious complications such as incarceration or vascular compression.3 Diagnosis is primarily clinical, with confirmation by imaging studies when necessary, and management typically involves surgical repositioning of the reservoir with repair of the defect.1
Clinical Context
Penile prosthesis reservoir herniation is encountered in the clinical setting of erectile dysfunction (ED) treatment using inflatable penile prostheses.1 The three-piece inflatable penile prosthesis, considered the gold standard surgical management for ED, consists of paired cylinders implanted in the corpora cavernosa, a scrotal pump, and a fluid reservoir typically placed in the space of Retzius or in an alternative submuscular location.3
Patient selection criteria for IPP implantation generally includes men with ED refractory to less invasive treatments such as phosphodiesterase-5 inhibitors and intracavernosal injection therapy.4 The procedure is performed through either a penoscrotal or infrapubic approach, with the penoscrotal approach being more commonly associated with reservoir herniation complications (97% of cases).1
Reservoir herniation typically presents in the immediate postoperative period, often associated with events that increase intra-abdominal pressure such as vigorous coughing or vomiting.1 Risk factors include obesity, chronic obstructive pulmonary disease, straining to void or defecate, previous pelvic surgery, and imperfect surgical technique.1,2 Patients with a history of radical prostatectomy or other pelvic surgeries may have altered pelvic anatomy, potentially increasing the risk of this complication.3
Diagnosis is primarily clinical, with patients presenting with a palpable bulge in the inguinal region or scrotum, often accompanied by discomfort.2 Imaging studies such as CT scan or ultrasound may be used to confirm the diagnosis and assess for complications such as incarceration.2 Management typically involves surgical intervention through an inguinal incision with concomitant closure of the external ring and replacement of the reservoir into its proper location.1 For patients presenting in the immediate postoperative period, some surgeons advocate replacement through the original penoscrotal incision.1
Prevention strategies include meticulous surgical technique, alternative reservoir placement locations for patients with hostile pelvic anatomy, and innovative approaches such as the THALIA technique (Tubing, Hitch and Lasso, Intussusception Anchor), which creates a mechanical stop to prevent reservoir migration.5 Modern reservoir designs, such as Rigicon’s AdaptiveReservoir™, feature shapes that naturally adapt to their intended location and incorporate lock valves to reduce complications.3
Expected outcomes following proper management of reservoir herniation are generally favorable, with most patients maintaining normal prosthesis function after successful repositioning.1 If left untreated, potential complications include incarceration, strangulation of abdominal organs if bowel is involved, implant malfunction, and vascular complications.2,3