{"id":12477,"date":"2025-05-16T09:34:27","date_gmt":"2025-05-16T13:34:27","guid":{"rendered":"https:\/\/www.rigicon.com\/glossary-term\/reservoir-placement\/"},"modified":"2026-10-07T01:28:59","modified_gmt":"2026-10-07T05:28:59","slug":"colocacao-do-reservatorio","status":"publish","type":"glossary-term","link":"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/colocacao-do-reservatorio\/","title":{"rendered":"Coloca\u00e7\u00e3o do Reservat\u00f3rio"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"featured_media":0,"template":"","glossary-category":[117],"glossary-product":[104],"class_list":["post-12477","glossary-term","type-glossary-term","status-publish","hentry","glossary-category-prosthetic-implants","glossary-product-infla10-pulse-ipp-series"],"acf":{"gt-definition":"<p>A coloca\u00e7\u00e3o do reservat\u00f3rio \u00e9 a etapa da cirurgia de pr\u00f3tese peniana infl\u00e1vel (IPP) de tr\u00eas volumes em que o reservat\u00f3rio de fluido, preenchido com solu\u00e7\u00e3o salina, \u00e9 posicionado na parte inferior do abdome. O dispositivo \u00e9 composto por um par de cilindros nos corpos cavernosos, uma bomba no escroto e um reservat\u00f3rio colocado no espa\u00e7o retrop\u00fabico (espa\u00e7o de Retzius) ou sob o m\u00fasculo reto abdominal ou a musculatura obl\u00edqua externa.<sup>1<\/sup> O espa\u00e7o de Retzius continua sendo um local habitual para implantes prim\u00e1rios, enquanto a coloca\u00e7\u00e3o submuscular ganhou popularidade por sua versatilidade e pelo menor risco de les\u00e3o visceral.<sup>2<\/sup> Na t\u00e9cnica submuscular alta, ou ect\u00f3pica, o reservat\u00f3rio fica anterior \u00e0 f\u00e1scia transversal, mas sob os m\u00fasculos abdominais.<sup>3<\/sup> Como a coloca\u00e7\u00e3o retrop\u00fabica geralmente \u00e9 realizada \u00e0s cegas, o paciente corre risco de les\u00e3o intestinal, vesical ou vascular,<sup>4<\/sup> e as Diretrizes da EAU descrevem complica\u00e7\u00f5es n\u00e3o infecciosas do reservat\u00f3rio, incluindo les\u00e3o da bexiga, do intestino e de vasos sangu\u00edneos.<sup>5<\/sup> Outros locais alternativos incluem o espa\u00e7o extraperitoneal alto, o espa\u00e7o retroperitoneal lateral em casos de pelve hostil e, principalmente em pacientes muito obesos, uma posi\u00e7\u00e3o subcut\u00e2nea.<sup>2,6<\/sup><\/p>","gt-synonyms":"Coloca\u00e7\u00e3o de reservat\u00f3rio submuscular alto, Coloca\u00e7\u00e3o de reservat\u00f3rio submuscular, Coloca\u00e7\u00e3o alternativa de reservat\u00f3rio, Coloca\u00e7\u00e3o de reservat\u00f3rio n\u00e3o tradicional, Coloca\u00e7\u00e3o de reservat\u00f3rio na parede abdominal, Coloca\u00e7\u00e3o de reservat\u00f3rio ect\u00f3pico IPP","gt-citation":"[1] Raikin J, Woodruff M, Meshekow G, Debski ND, Germaine P, Gor R. Urologic prosthetics: an imaging review of short- and long-term complications. Abdom Radiol (NY). 2025;50(1):290-304. doi:10.1007\/s00261-024-04491-6. PMID: 38985291.\n\n[2] Ivan S, Pryor J, Maffucci F, Simhan J. Reservoir placement options: a state of the art review. Int J Impot Res. 2025. doi:10.1038\/s41443-025-01082-x. PMID: 40355695.\n\n[3] Gupta NK, Ring J, Trost L, Wilson SK, K\u00f6hler TS. The penoscrotal surgical approach for inflatable penile prosthesis placement. Transl Androl Urol. 2017;6(4):628-638. doi:10.21037\/tau.2017.07.32. PMID: 28904895.\n\n[4] Patel J, Zakkar B, Polchert M, Tannenbaum J, Dick B, Raheem O. Recent technological development of penile prosthesis: a literature review. Transl Androl Urol. 2024;13(1):165-184. doi:10.21037\/tau-22-741. PMID: 38404551.\n\n[5] Salonia A, Boeri L, Capogrosso P, et al. EAU Guidelines on Sexual and Reproductive Health. Edn. presented at the EAU Annual Congress, Madrid 2025. EAU Guidelines Office, Arnhem, The Netherlands. ISBN 978-94-92671-29-5.\n\n[6] Michael S, Grice P, Oumeziane A, et al. Recognition to repair: Managing reservoir complications in inflatable penile prosthesis surgery. BJUI Compass. 2026;7(7):e70246. doi:10.1002\/bco2.70246. PMID: 42415952.\n\n[7] Atwater B, Krug A, Gross MS, Marty-Roix R, Chapin L, Morey AF. A review of the safety and efficacy of inflatable penile prosthesis ectopic reservoir placement. Sex Med Rev. 2025;13(1):20-32. doi:10.1093\/sxmrev\/qeae067. PMID: 39487491.\n\n[8] Sedigh O, Soleimanzadeh F, Buffi N, et al. Penile implant reservoir placement methods: is there a gold standard? Asian J Androl. 2026;28(1):16-22. doi:10.4103\/aja202593. PMID: 41508316.\n\n[9] Kava BR, Lopategui DM, Levine A, Ramasamy R. Trans-Fascial Placement of a High, Sub Muscular Reservoir in Patients Following Radical Cystectomy: Safety, Efficacy, and Predictability of Final Reservoir Location Verified With Abdominal Imaging. J Sex Med. 2019;16(2):338-345. doi:10.1016\/j.jsxm.2018.12.015. PMID: 30770075.\n\n[10] Ioannis M, Georgios L, Stavros T, Anastasios A, Koenraad VR. Update on penile prosthesis. Asian J Androl. 2026;28(1):23-30. doi:10.4103\/aja2024100. PMID: 40341570.\n\n[11] O'Rourke TK Jr, Erbella A, Zhang Y, Wosnitzer MS. Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction. Transl Androl Urol. 2017;6(Suppl 5):S832-S848. doi:10.21037\/tau.2017.06.07. PMID: 29238663.\n\n[12] Al-Enezi A, Al-Khadhari S, Al-Shaiji TF. Three-piece Inflatable Penile Prosthesis: Surgical Techniques and Pitfalls. J Surg Tech Case Rep. 2011;3(2):76-83. doi:10.4103\/2006-8808.92798. PMID: 22413049.\n\n[13] Kavoussi M, Cook GS, Nordeck SM, et al. Distance From Critical Pelvic Structures: Radiographic Comparison of High Submuscular and Space of Retzius IPP Reservoir Placement Techniques. Urology. 2022;160:136-141. doi:10.1016\/j.urology.2021.11.034. PMID: 34902353.\n\n[14] Ziegelmann MJ, Viers BR, Lomas DJ, Westerman ME, Trost LW. Ectopic Penile Prosthesis Reservoir Placement: An Anatomic Cadaver Model of the High Submuscular Technique. J Sex Med. 2016;13(9):1425-1431. doi:10.1016\/j.jsxm.2016.06.012. PMID: 27475239.\n\n[15] Kavoussi M, Cook GS, Nordeck SM, et al. Radiographic Assessment of Inflatable Penile Prosthesis Reservoir Location Variability in Contemporary Practice. J Sex Med. 2021;18(12):2039-2044. doi:10.1016\/j.jsxm.2021.09.015. PMID: 34753688.\n\n[16] Osmonov D, Chomicz A, Tropmann-Frick M, Arndt KM, J\u00fcnemann KP. High-submuscular vs. space of Retzius reservoir placement during implantation of inflatable penile implants. Int J Impot Res. 2020;32(1):18-23. doi:10.1038\/s41443-019-0201-4. PMID: 31562495.","gt-clinical-context":"<p>O hist\u00f3rico do paciente, como uma prostatectomia pr\u00e9via, pode levar os cirurgi\u00f5es a optar pela coloca\u00e7\u00e3o ect\u00f3pica do reservat\u00f3rio em vez da retrop\u00fabica.<sup>7<\/sup> O risco de les\u00e3o durante a inser\u00e7\u00e3o do reservat\u00f3rio \u00e9 maior em homens com hist\u00f3rico de prostatectomia radical, cistectomia, radioterapia p\u00e9lvica ou corre\u00e7\u00e3o de h\u00e9rnia com tela, nos quais a fibrose oblitera os planos naturais; para essa anatomia p\u00e9lvica hostil, recomenda-se como estrat\u00e9gia principal um local submuscular alto, extraperitoneal ou outro local ect\u00f3pico.<sup>6<\/sup> Revis\u00f5es tamb\u00e9m incluem a cistectomia radical com reconstru\u00e7\u00e3o de neobexiga, o transplante renal e a corre\u00e7\u00e3o de h\u00e9rnia inguinal entre as cirurgias p\u00e9lvicas pr\u00e9vias desafiadoras.<sup>8<\/sup> Em 12 homens submetidos a cistectomia radical, a coloca\u00e7\u00e3o submuscular alta transfascial foi descrita como um m\u00e9todo seguro, com uma hernia\u00e7\u00e3o do reservat\u00f3rio durante o seguimento.<sup>9<\/sup> Para pacientes considerados de alto risco de complica\u00e7\u00f5es com a coloca\u00e7\u00e3o do reservat\u00f3rio, como ap\u00f3s cirurgia abdominal pr\u00e9via, as Diretrizes da EAU consideram a pr\u00f3tese infl\u00e1vel de dois volumes uma op\u00e7\u00e3o vi\u00e1vel,<sup>5<\/sup> pois ela evita um reservat\u00f3rio intra-abdominal.<sup>10<\/sup><\/p>\n<p>A t\u00e9cnica visa proteger a bexiga e assegurar a coloca\u00e7\u00e3o na camada pretendida. O cateterismo uretral antes da coloca\u00e7\u00e3o do reservat\u00f3rio \u00e9 uma etapa cr\u00edtica para reduzir o risco de perfura\u00e7\u00e3o da bexiga.<sup>11<\/sup> A coloca\u00e7\u00e3o correta e um teste de contrapress\u00e3o ap\u00f3s o enchimento s\u00e3o descritos como obrigat\u00f3rios para prevenir a autoinsufla\u00e7\u00e3o.<sup>12<\/sup> Na coloca\u00e7\u00e3o ect\u00f3pica, cria-se um espa\u00e7o acima da f\u00e1scia transversal e o reservat\u00f3rio \u00e9 deslocado o mais superiormente poss\u00edvel; a f\u00e1scia de Scarpa deve ser transposta, caso contr\u00e1rio o reservat\u00f3rio acaba no subcut\u00e2neo, criando um abaulamento vis\u00edvel e palp\u00e1vel.<sup>3<\/sup> Uma contraincis\u00e3o separada ou uma abordagem transfascial sob vis\u00e3o direta pode substituir a passagem transinguinal \u00e0s cegas.<sup>8<\/sup><\/p>\n<p>Uma revis\u00e3o sistem\u00e1tica de 70 artigos, abrangendo 9.565 pacientes, n\u00e3o encontrou taxas elevadas nos desfechos de seguran\u00e7a entre a coloca\u00e7\u00e3o retrop\u00fabica e a ect\u00f3pica e considerou a coloca\u00e7\u00e3o ect\u00f3pica compar\u00e1vel em seguran\u00e7a, efic\u00e1cia e satisfa\u00e7\u00e3o do paciente.<sup>7<\/sup> Em exames de imagem seccionais, os reservat\u00f3rios submusculares altos tiveram menor probabilidade do que os retrop\u00fabicos de causar efeito de massa sobre a bexiga (9% vs. 72%) ou sobre os vasos il\u00edacos (4% vs. 34%).<sup>13<\/sup> Ainda assim, a coloca\u00e7\u00e3o \u00e0s cegas \u00e9 imprecisa: em um modelo cadav\u00e9rico, 80% dos reservat\u00f3rios submusculares altos ficaram anteriores \u00e0 f\u00e1scia transversal, mas 10% ficaram retroperitoneais, 5% pr\u00e9-peritoneais e 5% intraperitoneais.<sup>14<\/sup> Nos pacientes, essa variabilidade n\u00e3o pareceu afetar a seguran\u00e7a, e as complica\u00e7\u00f5es relacionadas ao reservat\u00f3rio permaneceram raras.<sup>15<\/sup> A palpabilidade \u00e9 a principal contrapartida: 64,3% dos homens com reservat\u00f3rios submusculares altos conseguiam sentir o reservat\u00f3rio imediatamente ap\u00f3s a cirurgia, embora isso tenha desaparecido em 80% desse grupo (IMC acima de 26,5) ap\u00f3s a forma\u00e7\u00e3o de uma c\u00e1psula aos 3 meses; 88% desses homens estavam satisfeitos, em compara\u00e7\u00e3o com 81% ap\u00f3s a coloca\u00e7\u00e3o retrop\u00fabica.<sup>16<\/sup><\/p>","gt-related-evidence":null,"gt-featured":false,"gt-ai-referenced":false,"gt-view-count":106},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.7 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Coloca\u00e7\u00e3o do Reservat\u00f3rio: Retrop\u00fabica vs. Ect\u00f3pica na IPP<\/title>\n<meta name=\"description\" content=\"Onde \u00e9 colocado o reservat\u00f3rio de fluido do implante peniano de tr\u00eas volumes, quando preferir locais submusculares ect\u00f3picos e quais complica\u00e7\u00f5es evitar.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/colocacao-do-reservatorio\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Coloca\u00e7\u00e3o do Reservat\u00f3rio: Pr\u00f3tese Peniana Infl\u00e1vel | Rigicon\" \/>\n<meta property=\"og:description\" content=\"Entenda a coloca\u00e7\u00e3o do reservat\u00f3rio na cirurgia de pr\u00f3tese peniana infl\u00e1vel. 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