Abstract Introduction Inflatable penile prosthesis (IPP) is the gold standard treatment for erectile dysfunction (ED) refractory to medical therapy and is associated with high patient satisfaction rates. Traditionally, the reservoir is placed in the space of Retzius; however, this approach can be technically challenging and may lead to serious complications, particularly in patients with a history of major pelvic surgery. Subscarpal reservoir placement (SRP) is an alternative in select patients with prior pelvic surgery. Objective To examine the efficacy and safety of the SRP of IPP reservoir placement. Methods Retrospective analysis of patients who underwent SRP by a single surgeon between May 2016 and September 2024. Patients were evaluated based on age, etiology of ED, history of radiation therapy (RT), body mass index (BMI), diabetes, hypertension, peripheral vascular disease, smoking status, immunosuppression status, prior abdominal surgery, history of Peyronie’s disease (PD), history of priapism, prosthesis type, surgical approach, postoperative complications, and reservoir-related complications. Patients were also asked whether the reservoir was palpable and to report their subjective level of bother, if any. Results A total of 35 patients were identified with SRP during the study period, with a mean age of 67.6 years (SD 7.6) and a mean BMI of 28.9 kg/m2 (SD 3.8). Of these, 71.4% (25/35) had previously undergone radical cystectomy (RC), while the remaining 28.6% (10/35) had undergone radical prostatectomy, associated with additional risk factors, including a history of oncologic colonic surgeries (6/35), pelvic fracture (1/35), or BMI 35 kg/m2 (3/35). All demographic variables are summarized in Table 1. A penoscrotal approach was used in 97.1% (34/35) of cases. A subcoronal approach was used in one patient due to the need for concomitant PD correction. The mean follow-up duration was 31.1 months (SD 29.5). Notably, there were no reservoir-related complications such as erosion or herniation. One patient developed an infection requiring IPP removal. Two patients experienced urethral erosion, necessitating device removal. Four patients presented with mechanical malfunction and subsequently underwent revision surgery. The response rate to the satisfaction survey was 45.6% (16/35). Among the respondents, 75% (12/16) reported palpable reservoirs; however, only 18.8% (3/16) reported being bothered by it. Conclusions SRP is a viable option for carefully selected patients with a history of major pelvic surgery. This approach is safe and associated with a low incidence of reservoir-related complications, such as herniation or erosion. Although many patients are able to palpate the reservoir, only a small proportion report being bothered by it. These findings underscore the importance of thorough preoperative counseling and expectation management in this high-risk population for reservoir-related complications. Disclosure No
Guo et al. (Mon,) studied this question.