(750) Retroperitoneal Reservoir Placement at Penile Prosthesis Implantation to Patients with Cystectomy History

Introduction Penile prosthesis implantation (PPI) is a surgical treatment for patients with refractory erectile dysfunction. Erectile dysfuction (ED) can occur often pelvic oncological surgeries of pelvis such as radical cystectomy. The general placement of the reservoir of the prosthesis to the space of Retzius is not a suitable option in this patient group and can carry the risk of injury to urinary diversion or gastrointestinal system. We present our experience with three post cystectomy 3-piece PPI cases in whom the reservoir was place at retroperitoneal space. Objective Our objective is to describe a safe and feasible alternative technique for penile prosthesis reservoir placement in patients with a history of radical cystectomy and ileal pouch urinary diversion, by presenting our institutional experience with retroperitoneal reservoir positioning in three patients. Methods Three patients with a history of cystectomy and ileal pouch urinary diversion for muscle-invasive bladder cancer underwent 3-piece penile prosthesis implantation. One patient had previously undergone robotic-assisted laparoscopic cystectomy, while the other two had open surgery. None of the patients showed evidence of recurrent or metastatic bladder cancer at the time of the procedure. The prosthesis cylinders were implanted into the corpora cavernosa, and the pump was placed in the scrotum following the standard technique. For reservoir placement, a 3–4 cm Gibson incision was made to access the retroperitoneum. The peritoneum was reflected medially, and Gerota’s fascia was mobilized. The psoas muscle was identified, and the reservoir was positioned between Gerota’s fascia and the lateral aspect of the psoas major muscle. The reservoir was filled with 80 mL of saline. The reservoir tubing was brought out of the abdomen, and a subdermal tunnel was created toward the scrotum for connection. After all components were connected, the procedure was completed with Coban bandage and dressing. The dressing was removed on postoperative day 2, and all patients were discharged on postoperative day 3. Patients were advised to maintain sexual abstinence for six weeks and were prescribed antibiotics, antifungal medications, and analgesics. Follow-up visits were scheduled at the first postoperative week, the sixth week, and annually thereafter. Results Postoperative imaging confirmed proper positioning of the reservoir within the retroperitoneal space, with no evidence of migration or displacement. Each of every patient had no complications or symptoms after the surgery in short term or long term. The prosthesis functionality was uneventful and no dissatisfaction was commented by the patients. Conclusions In patients with prior cystectomy (often with dense pelvic adhesions and, in some cases, prior radiotherapy), traditional retropubic reservoir placement may increase the risk of bowel, vascular, or urinary diversion injury. This situation can create undemanded consiquences at the step of placing reservoir in penile prosthesis surgery. The retroperitoneal reservior placement can be a safe and feasible alternative that avoids gastrointestinal and urinary diversion complications in this patients with high risk of complications. Disclosure No