(240) INTRA-VESICAL SPONTANEOUS RESERVOIR MIGRATION IN A 14 YEAR OLD INFLATABLE PENILE PROSTHESIS IMPLANT
Authors: Nardozza Jr. A , Cabrini MR 
Published: December 2024

Abstract

Introduction
Inflatable penile prosthesis (IPP) implantation represents a cornerstone therapeutic modality for managing erectile dysfunction refractory to pharmacotherapy. While IPP procedures are generally safe and efficacious, spontaneous migration of the components of the device to adjacent tissues, albeit rare, have been documented in the literature. Despite the limited number of reported cases, the clinical implications of such occurrences underscore the importance of heightened vigilance and comprehensive understanding among prosthetist surgeons.

Objective
Our objective is to elucidate an exceptionally rare case of reservoir-related complication associated with infection, leading to surgical intervention, thereby contributing to the body of knowledge surrounding IPP procedures and associated complications.

Methods
We present the clinical case of a 74-year-old male with a history of erectile dysfunction after open radical prostatectomy, who underwent IPP placement approximately 14 years ago. The patient presented with complaints of mild penile discomfort and recurrent urinary tract infections, alongside maintained functionality of the penile prosthesis. Diagnostic imaging with computed tomography and cystoscopy confirmed the presence of the IPP reservoir within the bladder, precipitating the need for surgical intervention.

Results
While conservative management of extruded prosthetic components is a viable strategy outlined in the literature, the presence of infection poses a formidable challenge, rendering this approach unfeasible. Following confirmation of positive urinary culture results, the patient was admitted initiating targeted antibiotic therapy, and then underwent a comprehensive surgical approach, comprising midline laparotomy, midline bladder open for reservoir removal, meticulous double-layer cystorrhaphy, followed by complete removal of the other components of the device. Post-operatively, the patient was transitioned to vacuum therapy and after 45-day convalescent period, the patient underwent successful re-implantation of a penile prosthesis, followed by contralateral prefascial, ectopic repositioning of the reservoir.

Conclusions
This case serves as a reminder of the potential complications associated with IPP procedures, particularly the rare but important phenomenon of spontaneous reservoir migration. Although the prosthesis was working, explantation was necessary due to the presence of infection. The successful management of this clinical scenario underscores the critical importance of prompt diagnosis. Moreover, this case underscores the necessity for continued vigilance and exploration into alternative reservoir placement techniques, particularly among patients with a history of abdomino-pelvic surgery, who may be inherently predisposed to heightened risks of complications. We aim to enrich the understanding of IPP-related complications and contribute to the refinement of clinical practice of urological prosthetic surgery.

Disclosure
No.