Introduction: Expert opinion is that when an implant malfunctions after 2 years it should be replaced in its entirety, despite the fact that reservoir removal is associated with serious potential complications. Furthermore, modern reservoir construction is such that material fracture and leak is rare. This analysis reviewed our experience with replacing only the reservoir in patients with malfunctioning 3-piece inflatable implants resulting from pump breakdown.
Methods: The study population consisted of (i) men who had had 3-piece inflatable penile implant surgery (ii) with device malfunction (iii) resulting from pump malfunction (iv) who had all other components functional (v) who underwent pump replacement alone and (vi) had =5 years follow-up after device repair (clinic visit, telephone call, letter). Only patients who had undergone a single prior implant operation were included. At the time of the repair, the pump was removed and replaced with a new pump, making sure that both cylinders and reservoir were filled fully intraoperatively and retained all fluid that was instilled. At the postoperative appointment, all patients were retrained in the correct means of device inflation, specially focused on avoidance of pump torqueing.
Results: 88 patients had pump tubing blow-out upon delivery of the pump at a mean duration post-primary implant of 9 ± 11 (2-16) years. Mean age 62 ±14 years. All patients had either a Mentor Alpha-1 or a Coloplast Titan devices placed. Tubing disruption was present =1cm from pump itself in 66 (75%) or >1cm from the pump in 22 (20%) patients. 25% had a blow out of the pump-reservoir tubing, while 66 (75%) had a tear in the pump-cylinder tubing (46 frayed tubing, 20 compete transection), evenly distributed between right and left-sided tubing. With a mean follow-up of 7±2.5 years, none of the devices had failed again.
Conclusions: In patients with a malfunctioning penile implant with proven pump-only failure, replacing the pump is a viable repair option, thus, circumventing the need for reservoir placement.
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