Abstract Introduction Inflatable penile prosthesis (IPP) implantation is the gold-standard surgical treatment for erectile dysfunction refractory to medical therapy. The reservoir is a key component of IPPs, and larger reservoirs have been introduced to optimize fluid dynamics and device functionality. However, their safety profile remains underreported. This study evaluates the outcomes of routinely using large reservoirs in IPP surgery. Materials and Methods We conducted a retrospective study of 60 patients who underwent IPP implantation with large reservoirs at Al Wakra Hospital between January 2022 and August 2024. Adult patients receiving standard reservoir placement in the space of Retzius were included, while those with altered pelvic anatomy from previous major pelvic surgery were excluded. Preoperative demographics, comorbidities, penile Doppler findings, prosthesis characteristics, and postoperative complications were recorded. All procedures were performed via a penoscrotal approach with standard antibiotic prophylaxis. Results The mean age of patients was 60.2 ± 9.1 years (range 34–77). Comorbidities were present in 76.6%, with diabetes in 65%. Penile Doppler revealed venous leak in 60%, arterial insufficiency in 21.7%, and mixed disease in 11.7%. Prosthesis types included Coloplast (63.3%), AMS (28.3%), and Rigicon (8.3%). Reservoir sizes used were 100 mL (28.3%), 125 mL (63.3%), and 110 mL (8.3%). Mean follow-up was 589.4 ± 416.5 days. No cases of migration, infection, urethral injury, erosion, device failure, pain, or LUTS were documented. One patient (1.6%) required revision due to superficial reservoir placement. Conclusion Routine use of large reservoirs in IPP surgery appears safe, with no increase in major complications. This strategy may provide functional advantages and simplify surgical workflow, especially in patients requiring higher fluid volumes. Larger prospective studies are warranted to validate long-term outcomes and patient satisfaction.
Alnadhari et al. (Sun,) studied this question.