Abstract Background Reservoir placement remains one of the most technically challenging components of inflatable penile prosthesis (IPP) surgery. The conventional approach involves placement in the retropubic space via an extraperitoneal route through the external inguinal ring. However, this method may pose significant risks in patients with prior major abdominopelvic surgeries or anatomical disruption. To present a safe and effective alternative for IPP reservoir placement in patients with complex surgical histories, specifically using the high sub-rectus space. Methods We report the case of a patient with extensive pelvic trauma, including bilateral inferior pubic ramus fractures with pubic diastasis, selective embolization of bilateral internal iliac arteries, exploratory laparotomy with colostomy, and posterior urethral rupture. Given the inaccessibility of the inguinal rings and altered pelvic anatomy, a high sub-rectus approach was used for reservoir placement—positioning it anterior to the posterior rectus fascia and posterior to the rectus muscle. Results The procedure was completed safely, with no complications, and the patient was discharged the next day. Surgical outcomes were equivalent to standard reservoir placement. Conclusions High sub-rectus reservoir placement is a safe and viable alternative for IPP surgery in patients with prior extensive abdominal or pelvic surgery and inaccessible inguinal anatomy. This technique minimizes the risk of intra-abdominal complications and preserves functional outcomes.
Cangüven et al. (Sun,) studied this question.