V10-09: Robot-assisted reservoir capsulotomy and mobilization to treat auto-inflation of an inflatable penile prosthesis
Auto-inflation of inflatable penile prostheses (IPPs) is an uncommon but bothersome complication for patients who encounter the issue, with pump cycling difficulties often causing pain and embarrassment. Incidence is estimated to be between 3-5% over the past decade. In this case, we present our experience with a 67-year-old male who noted auto-inflation of his IPP four-weeks after placement, and who was managed with a novel, robot-assisted laparoscopic approach to mobilize the reservoir.
The patient was counseled on management options including observation, device explantation, open revision, and our robot-assisted laparoscopic approach, for which he provided informed consent. His prior operations included a robotic prostatectomy, as well as his IPP placement (Coloplast® Titan Touch®, Coloplast, Minneapolis, MN). Trocars were placed in an inverted U-shaped configuration similar to a robotic prostatectomy setup. Pre-operative CT imaging revealed that the reservoir was in close proximity to the iliac vessels in the space of Retzius on the left side. Following lysis of adhesions from his prior surgery, attention was turned to the left lower quadrant of the abdomen. Intraoperative ultrasonography with Doppler was used to identify the reservoir and distinguish it from surrounding vessels. The preperitoneal space was carefully entered and the reservoir was visualized. A thin encapsulation around the reservoir was skeletonized. The reservoir was noted to remain tethered in place by the left inferior epigastric vessels, which were ligated to fully mobilize the reservoir. The device was cycled on the field and the prosthesis was noted to remain appropriately deflated._x000D_
Total operative time was 90 minutes, with an EBL of 20 mL. The patient discharged home the same day. There were no intraoperative complications. At follow-up in two and four weeks, the patient reported excellent pump cycling quality, resolution of his pain and discomfort, and no further episodes of auto inflation. He has begun using his device and is satisfied with the quality of his erections.
The most common causes of IPP auto-inflation include insufficient space creation at the time of reservoir placement, with post-prostatectomy patients being at higher risk due to an obliterated space of Retzius. Our case represents a novel approach of reservoir revision that affords advantages in ergonomics, visualization, and fine dissection offered by the robot-assisted modality in the minimally invasive setting.