Simultaneous 3-Piece IPP at the Time of Robotic Prostatectomy: An “In Vivo” Characterization of Submuscular Reservoir Placement

Author(s): Matthew Brennan, Jacob Lucas, Steve Sterious, Mohammed Haseebuddin, Alexander Kutikov, Jay Simhan

Key words: Inflatable penile implant, Alternative reservoir placement

While maintenance of potency following robotic prostatectomy (RP) is a primary goal, postoperative erections will be poor in patients with pre-existing impotence prior to surgery. Following RP, many urologists are hesitant to proceed with 3-piece inflatable penile prosthesis (IPP) placement either concomitantly or in a delayed fashion due to concerns over reservoir placement into scarred planes secondary to the obliteration of the space of Retzius (SOR). We present a series of patients with preoperative impotence undergoing simultaneous RP with IPP placement.

Our RP technique involved a posterior dissection followed by the dropping of the bladder and subsequent obliteration of the SOR.  Immediately following completion of the RP, we performed a penoscrotal approach for IPP placement. The reservoir was placed through this incision beneath the rectus muscle using an atraumatic double-articulating forceps. Great care was taken to advance the clamp parallel to the rectus muscle in order to prevent inadvertent perforation of the transversalis fascia. A laparoscope and external camera were utilized to capture reservoir placement.

We successfully performed our technique in 3 patients (median age 61, range 61-63). All 3 patients (median BMI 30, range 23-30) manifested notable pre-existing erectile dysfunction refractory to medication and/or ICI (median SHIM 10, range 8-17).  Operative times decreased steadily (median 5:48, range 4:48-6:50) as our experience increased with this procedure. All patients underwent implantation of a Coloplast IPP that was FDA approved for submuscular reservoir placement. No patients experienced device palpability or manifested an abdominal bulge secondary to the submuscular reservoir. All patients were using their devices on follow-up with excellent device-related satisfaction.

Carefully selected patients with pre-existing impotence and localized prostate cancer may safely undergo IPP placement at the time of RP.  We demonstrate important anatomic considerations during reservoir placement.  This further offers impotent patients an opportunity to gain potency during RP recovery.

Acknowledgements: Coloplast MD (facilitated video editing)

Disclosures: Jay Simhan is a consultant for Coloplast and Boston Scientific/AMS, no other disclosures