Reservoir Placement

Ectopic reservoir placement is clinically indicated when the traditional space of Retzius is considered hostile or unsuitable for reservoir placement during inflatable penile prosthesis (IPP) surgery.¹ This often occurs in patients with a history of prior pelvic surgeries (e.g., radical prostatectomy, cystectomy), pelvic radiation therapy, or significant pelvic trauma, which can lead to scarring, adhesions, or altered anatomy, increasing the risk of complications such as bladder, bowel, or vascular injury if the reservoir is placed in the conventional location.¹,³,² Patient selection criteria for ectopic placement typically include individuals undergoing IPP implantation for erectile dysfunction who have these pre-existing pelvic conditions.¹ The surgical procedure for ectopic placement involves creating a space for the reservoir in an alternative location, most commonly submuscularly (e.g., high submuscular, between the abdominal muscles and the transversalis fascia) or, less commonly, in the lateral retroperitoneal space.¹,³ The surgeon dissects this alternative pocket, often via the same penoscrotal or infrapubic incision used for cylinder placement, or sometimes through a small counterincision. Specialized instruments may be used to create the pocket and insert the reservoir safely.²,³ Expected outcomes for ectopic reservoir placement are generally comparable to traditional placement in terms of device function, patient satisfaction, and cosmetic results, with the primary advantage being a reduced risk of visceral injury in high-risk patients.¹,³ However, surgeons must be meticulous in technique to avoid potential complications specific to ectopic sites, such as reservoir palpability or migration, though reports of such issues are relatively low when performed correctly.²,³ Long-term studies continue to affirm the safety and efficacy of ectopic techniques when standard retropubic placement is contraindicated.¹