Iatrogenic injuries to reservoirs of inflatable penile prosthesis during urologic surgery: a scoping review and case report.

Abstract

Introduction: First-line treatment options for patients with erectile dysfunction whose medical management has failed include the inflatable penile prosthesis (IPP). Many patients with an IPP require subsequent urologic surgery, during which the reservoir of the IPP can be injured.

Objectives: This review aims to present a summary of current literature related to iatrogenic injuries to the IPP sustained during urologic surgery.

Methods: Two reviewers independently performed a systematic search on PubMed using standardized search terms to identify pertinent articles. After preliminary review, relevant studies were analyzed to identify the presence of perioperative complications resulting in IPP reservoir injury. Results were categorized by surgical procedures.

Results: Among 13 articles included, all were based on urologic surgery. Four studies identified IPP reservoir injury as a result of surgical injury. Of these, injuries occurred during radical prostatectomy (n = 3) and prostatic urethral lift surgery (UroLift, n = 1). Most radical prostatectomy studies without IPP reservoir injuries also described intentional surgical techniques that were employed to prevent reservoir damage, including modulation of reservoir inflation-deflation (n = 3), temporary reservoir repositioning (n = 1), or reservoir capsule dissection to improve visualization (n = 1). Findings from an additional novel case report on IPP injury during a UroLift procedure are presented in this review.

Conclusion: Approximately one-third of studies identified intraoperative IPP reservoir injury as a significant complication of urologic surgery, particularly during radical prostatectomy. Novel case report findings also contribute the only other case of IPP reservoir damage sustained from delivery of UroLift implants. Findings are used to create a standardized surgical checklist that guides perioperative planning measures prior to pursuing surgery in adjacent spaces.