Traditional Reservoir Placement and Ectopic Reservoir Placement IPP & AUS

VJPU 2018; 2: 122

Title: Traditional Reservoir Placement and Ectopic Reservoir Placement IPP & AUS

Authors: D. Osmonov, F. Prell, K-P Juenemann
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel. Germany

This video demonstrates different methods of reservoir placement during the implantation of an inflatable penile prosthesis and an artificial urinary sphincter.

IPP reservoir placement: Reservoir placement is regularly performed after implantation of the both cylinders. The external inguinal ring must be identified by placing a hook in the inguinal canal. The transversalis fascia is perforated by the non-dominant finger in the medial aspect of the inguinal ring towards the pubic bone straight to the midline. The space of Retzius is expanded for the reservoir, followed by reservoir placement. We have demonstrated the anatomical landmarks of extraperitoneal reservoir implantation in the cadaver. To this end, we installed both the conventional and the laparoscopic camera extraperitoneally. A clover-leaf reservoir is placed, using Wilson´s telescopic clam to open up the created space.
Our next clip demonstrates high submuscular reservoir placement as described by Alan Morrey. The illustration shows us the ballpark height of the reservoir position. We used another cadaver in order to demonstrate the anatomical landmarks. The position of the reservoir is straight submuscular. The reservoir is located above the arcuate line behind the posterior rectus sheath. As demonstrated in these anatomical illustrations, the high submuscular position of the reservoir behind to the posterior sheath is ideal for avoiding collision with the epigastric vessels.

AUS Reservoir Placement: AUS Reservoir implantation can be done in the space of Retzius, in analogy to the IPP Reservoir implantation. The implantation technique is similar to the IPP Reservoir implantation. In case of previous pelvic or abdominal surgery, ectopic high submuscular reservoir placement of the AUS Reservoir can be performed.

Conclusion: IPP and AUS Reservoirs placement in space of Retzius is a traditional implantation method used in most of the cases. In many high volume centers IPP or AUS Reservoirs are implanted ectopically in patients with previous abdominal surgery., accordinglto our experience, however, ectopic high submuscular reservoir placement can be widely used even in virgin patients. Both methods are well described and can be performed safely.