Surgical steps and relevant anatomical landmarks for the implantation of an inflatable penile prosthesis reservoir placed in the retropubic and submuscular abdominal ("ectopic") space.

Abstract

Surgical implantation of an inflatable penile prosthesis is considered the gold-standard treatment for severe erectile dysfunction. Reservoir placement is one of the most challenging steps of this procedure and requires knowledge of the related anatomy. To meet these demands, we have established a postgraduate masterclass program on penile prosthesis implantation that identifies the essential anatomical landmarks demonstrated in predissected anatomical specimens and offers a step-by-step surgical training carried out in body donors under tutored guidance. The main focus of this study is the technical application of our didactic and educational approach by providing high-quality descriptive anatomical illustrations. Surgical steps and anatomical structures relevant for reservoir placement in both the retropubic ("traditional") and submuscular abdominal ("ectopic") spaces are described and visualized. Anatomical dissections were performed by clinical anatomists in close collaboration with high-volume implanters and reconstructive surgeons. This unique cooperation between theoretical and practical disciplines allowed a detailed focus on shared anatomical targets, providing a comprehensive understanding of the key landmarks in the context of reservoir placement. These technical guidelines and anatomical considerations are indispensable prerequisites for minimizing the risk of complications associated with reservoir placement.