Andrew C Kramer1, Juddson Chason, Alan Kusakabe. 1. The University of Maryland School of Medicine-Surgery, 22 S. Greene St., Baltimore, MD 21231, USA. akramer@smail.umaryland.edu
Abstract
INTRODUCTION: Rupture of penile prosthesis reservoir into the bladder is an unusual and unexpected occurrence after prosthesis component replacement for malfunction. Scant literature exists describing a pathophysiology, diagnosis, and repair with device salvage. AIM: Our goal is to describe an uncommon event in prosthetic surgery, and discuss the pathophysiology and ways to treat and perhaps avoid this occurrence. METHODS: Two patients presented with gross hematuria in the recovery room following repair of a cylinder to pump tubing break of their inflatable penile prostheses (IPPs). In each operation, the existing reservoir had been left in situ and refilled once placed in circuit with new cylinders and pump. RESULTS: The reservoirs had immediately ruptured into the bladder upon refilling, and were identified intravesically on cystoscopy and computed tomography scan. A one-step approach can be done to salvage the device, remove the eroded reservoir with bladder repair, and new reservoir placed directly into appropriate space. Interpretation. During IPP revision, even when a reservoir is not manipulated simple tubing repair performed, gross hematuria in the recovery room likely signals bladder perforation. We include recommendations for reservoir management with implant revision, as well as surgical management and prevention of this complication. CONCLUSIONS: Bladder perforation can be caused by penile implant revision even when the old reservoir is not manipulated. If this complication occurs, it can be surgically managed immediately. This can also potentially be avoided.
INTRODUCTION: Rupture of penile prosthesis reservoir into the bladder is an unusual and unexpected occurrence after prosthesis component replacement for malfunction. Scant literature exists describing a pathophysiology, diagnosis, and repair with device salvage. AIM: Our goal is to describe an uncommon event in prosthetic surgery, and discuss the pathophysiology and ways to treat and perhaps avoid this occurrence. METHODS: Two patients presented with gross hematuria in the recovery room following repair of a cylinder to pump tubing break of their inflatable penile prostheses (IPPs). In each operation, the existing reservoir had been left in situ and refilled once placed in circuit with new cylinders and pump. RESULTS: The reservoirs had immediately ruptured into the bladder upon refilling, and were identified intravesically on cystoscopy and computed tomography scan. A one-step approach can be done to salvage the device, remove the eroded reservoir with bladder repair, and new reservoir placed directly into appropriate space. Interpretation. During IPP revision, even when a reservoir is not manipulated simple tubing repair performed, gross hematuria in the recovery room likely signals bladder perforation. We include recommendations for reservoir management with implant revision, as well as surgical management and prevention of this complication. CONCLUSIONS: Bladder perforation can be caused by penile implant revision even when the old reservoir is not manipulated. If this complication occurs, it can be surgically managed immediately. This can also potentially be avoided.
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