Intra-Abdominal Reservoir Placement During Penile Prosthesis Surgery in Post-Robotically Assisted Laparoscopic Radical Prostatectomy Patients: A Case Report and Practical Considerations

Abstract

INTRODUCTION: Robotically assisted laparoscopic radical prostatectomy (RALP) provides decreased surgical morbidity and faster recovery for patients, but has not significantly changed the incidence of erectile dysfunction and many post RALP patients may require penile prosthesis surgery. AIM: To make physicians aware of the anatomical changes after RALP in comparison to traditional retropubic radical prostatectomy and to make suggestions for safer reservoir placement. MAIN OUTCOME MEASURES: Reservoir location after RALP. METHODS: A 68 year-old patient with severe vasculogenic ED refractory to pharmacologic management following RALP underwent a 3-piece penile prosthesis insertion surgery and laparoscopic right lower abdominal hernia repair. Laparoscopy revealed an intraperitoneal reservoir that was overlying the sigmoid colon with multiple diverticula. The reservoir was laparoscopically repositioned in the dependent pelvis away from the diverticula and the pelvic vessels. RESULTS: The patient's postoperative course was uneventful without any postoperative complications (2 year follow up). CONCLUSIONS: The altered anatomy of the space of Retzius following RALP will likely result in significantly more cases of inadvertent intraperitoneal reservoir placement. Surgeons performing inflatable penile prosthesis surgery should be aware of these anatomical changes and prepared to consider ectopic reservoir placement when necessary.