Urology

May 21, 2022

"An inflatable penile prosthesis (IPP) continues to be an excellent option for men with erectile dysfunction over medication. Recent American Urological Association (AUA) guideline changes now encourage men and providers to consider penile implant surgery after oral medications and lifestyle changes have failed," states Tobias S. Kohler, M.D., M.P.H., a urologist at Mayo Clinic in Rochester, Minnesota. The fluid reservoir of the penile implant allows excellent concealability and use of the device, which typically holds about 75 to 100 mL of normal saline. The reservoir is placed in one of two locations: in the Retzius space placed through the abdominal fascia or in an alternate location typically referred to as submuscular or ectopic placement.

Submuscular reservoir placement

Dr. Kohler notes that "submuscular reservoir placement has greatly improved the safety of IPP surgery as this reservoir resides well away from potentially at-risk structures such as the iliac vein, bladder and sometimes even bowel." A penile implant reservoir adjacent to the bowel can occur when the patient undergoes a robotic prostatectomy and the reservoir is placed in the traditional Retzius space location. A rare complication of the safer submuscular reservoir location is migration of the reservoir to an unwanted position.

The THALIA technique

Dr. Kohler and colleagues at Mayo Clinic invented a technique to prevent reservoir migration: Tubing, Hitch and Lasso, Intussusception Anchor (THALIA). An extra collar that comes standard with the penile implant creates a stopping point for the reservoir. A small extra collar that is sewn into place and incorporated on the reservoir tubing acts as a doorstop to prevent the reservoir from moving to an unwanted location.

The THALIA technique can also be used to prevent migration of the reservoir into other parts of the body. For example, reservoirs can reside next to bowel or great vessels. Occasionally, it is safer to leave old reservoirs behind when replacing penile implants, using a drain and retain strategy.

When using this tactic, the reservoir can migrate to locations next to the kidney or even the pancreas. Thus, Dr. Kohler's team also recommends using a THALIA stitch to keep retained reservoirs from leaking. To date, about 100 patients have had a THALIA stitch, resulting in minimal addition to operative time and positive outcomes.

For more information

Refer a patient to Mayo Clinic.