Options for Managing the Penile Prosthesis Reservoir During Revision Surgery

Penile implants have come a long way, from using rib cartilage in the past to modern silicone devices, offering a reliable solution for men with severe erectile dysfunction (ED). Today’s inflatable penile prostheses (IPPs) are highly durable, with most working well for over 10 years. However, over time, these devices can fail either due to mechanical problems (like broken parts) or non-mechanical issues (like erosion or infection).

Infections require the entire device to be removed, but for noninfected cases, surgeons have more flexibility, particularly with the reservoir – the part of the device that holds fluid. Removing the reservoir can sometimes lead to serious complications, like damage to nearby blood vessels or organs. To avoid these risks, surgeons may leave the nonfunctional reservoir in place after draining it (a method called “drain and retain”).

A recent study looked at a newer approach called “reservoir recycling,” where the reservoir is reused and connected to new parts of the implant. The goal was to see if this method is as safe and effective as draining and retaining the reservoir or fully replacing it during revision surgeries.

To do this, the researchers reviewed cases of penile implant revision surgeries performed by a single surgeon from 2007 to 2022. They focused on three reservoir management methods: full replacement (FR), drain and retain (DR), and reservoir recycling (RR). During surgery, reservoirs considered for recycling were thoroughly cleaned, flushed with sterile saline, and tested for leaks to ensure they could be safely reused. If a reservoir showed issues or was difficult to access, it was either removed or drained and left in place.

The team analyzed patient data, including complications, time to further revisions, and surgery duration, to compare the three methods. Statistical tests were used to evaluate infection rates, mechanical failures, and other outcomes. This approach allowed researchers to assess whether reservoir recycling was as safe and effective as the other methods.

Of the 140 surgeries reviewed, the majority (about 90%) used a high submuscular (HSM) location for the reservoir, which means placing the reservoir beneath the muscle, specifically higher up, near the upper part of the pelvis or pubic region. A smaller number of surgeries placed it in the retropubic space, which is the area behind the pubic bone.

The study found that all three reservoir management groups (FR, DR, and RR) had similar patient demographics, including age, body mass index (BMI), and comorbidities like heart disease and diabetes. The median follow-up time was about 4.5 months for all groups.

In terms of mechanical failure (e.g., leaks or pump malfunctions), RR had a slightly higher failure rate than DR, but this wasn’t significant when comparing all three groups. Notably, the RR group had a low infection rate (0%), compared to DR (6.3%) and FR (4.8%).

Reservoir recycling avoids the need for more invasive surgery, such as creating additional incisions, which could cause complications like bowel or bladder injury. As such, this study suggests that recycling the reservoir is a safe option with no increased risk of infection or major complications compared to the other methods. Nevertheless, there’s a small chance of a hidden leak over time, which may not be noticed immediately after surgery.

Overall, reservoir recycling provides a less invasive, effective option for revision surgeries, particularly for patients who need fewer risks and a quicker recovery. However, there were some limitations. It was retrospective (looking back at past data) and had a small sample size, meaning the results might not apply to all patients. The follow-up period was also short, so the long-term effects are unclear. Future studies with larger groups and longer follow-ups are needed to confirm these findings and provide more reliable conclusions.

References:

Amini, A. D., Nealon, S. W., Badkhshan, S., Langford, B. T., Matz, E. L., VanDyke, M. E., Franzen, B. P., & Morey, A. F. (2025). Management of the inflatable penile prosthesis reservoir at time of revision surgery: Remove, retain, or recycle? The Journal of Sexual Medicine, 22(1), 170–174. https://doi.org/10.1093/jsxmed/qdae155