Introduction: IPP surgery is an established strategy for men with ED refractory to medical therapy. IPP is especially more complex after RC especially given that bowel loops may descend into the pelvis, complicating reservoir placement. We aimed to report our experience with 3p IPP in men with previous RC.
Methods: Demographic, comorbidity profiles and implant surgery data were recorded. Men who failed oral and intracavernosal injection therapy had IPP surgery discussed. After opting for IPP surgery, the most recent CT scans were reviewed with a radiologist and if no bowel loops were present within the pelvis, a 3-piece device was planned. Otherwise, a 2-piece was placed. Prior to 2014 (n=48), the reservoir was placed in the space of Retzius (SOR) or in a submuscular space via the inguinal ring (SM) or in a high sub-rectus ectopic location (E). After this date (n=30), only an E location was used.
Results: 78 men were included in the analysis with a mean age of 63 ± 12 years. 10% had diabetes. Median number of vascular comorbidities was 2 (1,3). 50% of the men had =2 comorbidities. For diversion, 50% had an ileal conduit, 10% cutaneous diversion, 40% neobladder. Median time between RC and IPP was 36 (18, 56) months. Reservoir locations (pre-2014): SOR 60%, SM 30%, E 10%. Two small bowel perforations occurred pre-2014, both with attempted SOR reservoir placement. Since then, using E reservoir placement, no bowel perforation has occurred. 2 IPP infections have occurred (1 pre-2014, 1 post-2014), both of which underwent successful salvage without repeat infection.
Conclusions: Despite a rigorous review of preoperative CT scans, 2/48 men suffered perforation. We have since abandoned SOR or SM reservoir placement in this population. Even in this complex populations, IPP infection rates were low.
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