Gross M S, Stember D S, Garber B B, Perito P E
Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Department of Urology, Mount Sinai Hospital, New York City, NY, USA.
Int J Impot Res. 2017 Sep;29(5):215-218. doi: 10.1038/ijir.2017.26. Epub 2017 Jun 29.
Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with ED refractory to medical management. We have previously demonstrated a protocol for IPP reservoir placement within the abdominal wall musculature, which was shown to be a safer location than traditional placement in the retropubic space of Retzius. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after abdominal wall placement of the reservoir. We retrospectively reviewed our two patients with peritoneal entry of the reservoir after posterior to transversalis fascia and anterior to transversalis fascia placement during virgin and compromised IPP cases, respectively. Our goal was to assess common inherent patient and surgical factors that resulted in this complication in order to develop a management algorithm to prevent future occurrence during alternative reservoir placement. Peritoneal reservoir entry was identified in two patients. These patients were both noted to be thin (mean body mass index (BMI) 18.5 kg/m), current or former smokers. Peritoneal entry was identified early after reservoir placement. Neither of the patients suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up. Peritoneal entry of the reservoir occurs very rarely and, in our series, occurred in a cohort of patients with low BMI and tobacco use history. We recommend early identification of similar patients and subsequent reservoir placement anterior to transversalis fascia with caution to prevent peritoneal entry.
对于药物治疗无效的勃起功能障碍（ED）男性患者，植入可膨胀阴茎假体（IPP）是最有效的治疗方式。我们之前已经展示了一种将IPP储液器置于腹壁肌肉组织内的方案，该位置比传统的耻骨后间隙（Retzius间隙）放置更安全。本研究的目的是回顾我们在将储液器置于腹壁后储液器进入腹膜的并发症情况。我们分别回顾了在初次和复杂IPP病例中，储液器在穿过腹横筋膜后和在腹横筋膜前放置时进入腹膜的两名患者。我们的目标是评估导致这种并发症的常见内在患者因素和手术因素，以便制定一种管理算法，以防止在替代储液器放置过程中未来再次发生。两名患者被发现储液器进入了腹膜。这两名患者均体型消瘦（平均体重指数（BMI）为18.5kg/m²），为当前或既往吸烟者。储液器放置后不久就发现了腹膜进入情况。两名患者均未发生肠损伤，随后均成功取出储液器并更换了IPP。在随访中，两人目前的IPP功能良好。储液器进入腹膜的情况非常罕见，在我们的系列病例中，发生在一组BMI较低且有吸烟史的患者中。我们建议早期识别类似患者，并随后谨慎地将储液器放置在腹横筋膜前，以防止进入腹膜。
