Ectopic Placement of Reservoir

[omega52]

I am relatively new to the board. I have searched for ectopic placement of implant reservoirs but there are no posts on this topic. I am currently scheduled for implant placement Dec 19th with Dr Kramer at University Maryland. My PSA has been slowly rising. I had a biopsy last year but it was negative. There is always the possibilty any of us may need and elect to have a prostatectomy. The biggest fear I have with an implant is the possibility of infection. The reservoir is normally placed in the Space of Reitz. I am not sure if that is the correct spelling. Anyway this is the same space that is invaded with a prostatectomy. In other words, if you have an implant first and then have a prostatectomy the reservoir or the implant can get infected from the prostate surgery. This may also be true if you have a biopsy of the prostate. That is a very scary thought since infection is the #1 reason for a failed implant.

I can't remember the big implant specialist in Miami but he frquently places reservoirs ectopically. My urologist understands this problem and so does Dr Kramer. As a result, the reservoir can be placed in another body compartment. It is somewhere under connective tissue in a more superficial location. The doc from Miami says that AMS makes a clover type reservoir that is made for ectopic placement and is virtually invisible to sight. I think placement would require an infrapubic approach vs a scrotal. Ectopic placement makes a lot of sense to me. With ectopic placement there is never a fear of infection with prostate surgery. I have read case studies of robotic prostatectomies being done in the Space of Reitz with no problems but it can sure open up a can of worms with respect to infection.

Any of you guys familiar with this?

Thanks,

Omega

[Dave48003]

I'm not sure what ectopic means. But, I had a prostate biopsy on March 9th and landed in the hospital with an infection the next day. Fortunately, the implant was fine. So, I'd be interested in knowing more!

[omega52]

Hey Dave,

I think this is a very relevant, critical topic. I did a little more research to get my spelling and verbiage correct. The typical placement of the reservoir in a three piece inflatable implant is in the Space of Retzius, which is beside the bladder. This is the same space where your prostate resides. Now many of the men on this board had an implant as the negative consequence of prostate surgery. This by the way would also include robotic Divinci prostatectomy which is supposed to be more of a nerve sparing surgery. We all have to live with possibility of prostate cancer.

Ectopic simply means being in a different space, not the typical space which is usually the Space of Retzius. Infection of a penile implant is the kiss of death for the implant. As the result of infection it needs to be removed with perhaps a revision surgery. What if a man has a penile implant with the reservoir placed in the typical Space of Retzius and then develops prostate cancer and elects to have a prostatectomy. If the prostate is in the space of Retzius what do you think may happen if the prostate gets infected from a biopsy or there is a post op infection following prostate surgery. You bet ya, the implant may get infected. What happens if the implant gets infected. You lose it. There lies the problem. I can tell you there are many urologists who lick their chops at prostate surgery. Some can be quick draws, others more cautious. Regardless you are are sitting there with your implant thinking, "Oh my God what if my implant gets infected".

Ectopic placement of the reservoir means that the reservoir is placed in a different place than the Space of Retzius. Dr Perito is the doc in Miami who is big on this. He does it routinely. Many surgeons either don't want to or don't know much about it. It is not a difficult thing to do for surgeons who are conversant with it. The reservoir is placed in an intra-abdominal space set completely apart from the Space of Retzius. As a result if you ever have prostate surgery or a biopsy with a possible infection you are safe from the untoward effect of infection of your implant. Some guys, post prostate surgery, have to have ectopic placement because of scarring in the Retzius area. There could be slight visibility of the reservoir in this more superficial area. However, there are numerous types of implants that have a flat reservoir that are made for ectopic placement. Perito makes these look easy. For many surgeons it may be more difficult and they do not want to do this. If I have an implant I am seriously looking at ectopic placement. I think I would live in eternal paranoia otherwise since I still have my prostate. That is unless someone convinces me otherwise which I was hoping someone on the board has had an experience with this.

Hope that helps.

Omega

[knotreel]

Omega, that is interesting. The placement in the retzius makes me wonder if a prostate biopsy could accidentally puncture a reservoir. Both my reservoirs were placed in my lower abdomen through an vertical incision above my pubic bone while the implants( IPP and AUS) were done with a scrotal incision, possibly they were placed above the retzius? I asked my doctor why the extra incision and he said he preferred not to place the reservoirs blindly up though the scrotum. I guess that if the resevoirs are placed through the scrotum, they would almost have to be in the area you call the retzius? I had no argument with the extra incision. I won't need a prostate biopsy since I don't have one any more, but still it makes me wonder.

[radiodec]

Oh Joy! Another scar tissue problem to be worried about with implants and radical prostatectomy. I have already had one difficulty with scar tissue. This was scar tissue in the neck of the bladder and cost me five weeks delay in starting the implant. Now, I get to worry about scar tissue where my urologist might want to put the reservoir for my implant. Novermber 7, I am going for an implant, second attempt. I don't know what other scar tissue will be encountered, I have a rather large scar from my naval to my penis from the RP. Well maybe they will be far enough along this time not to postpone for repairs.

Radiodec

[omega52]

Knotreel, I think many times after a RP there is scarring in the Retzius space which could make placement there difficult, requiring placement of the reservoir in an ectopic postion by an infrapubic vs scrotal approach. You can place the reservoir in the Retzius space through the scrotum but if you want it in an ectopic postion you would need an incision in the infrapubic area.
My perspective is placing the reservoir in the infrabdominal area before any prostate work of any kind is done to prevent infection from a possible RP or biopsy.
Omega

[omega52]

Radiodec, Maybe you don't have scarring in the Retzius area and it will not be a problem. At least your prostate is out so you don't have to worry about infection from the prostate to your implant. My guess is you will be fine. Wish you the best with your implant surgery.

Omega

[radiodec]

Well, I am through surgery and in very good shape minimal discomfort with lots to report.

Scar tissue, loads of it, don't have particulars yet. Surgery that was scheduled to take 1.5 hours took 2.5 hours. I now have what you would call an ectopic placement of the reservoir. It is on the right and above, get more data when talk to urologist. Very lille pain or discomfort, most pain from any stretching pressure against alternate placement area. Alternate placement caused by scar tissue for ancient undescended left testicle repair and concurrent hernia repair under location of testicle in canal.


The surgery went well other than being long, the most pain was froma catheter that would lose drain all the time and back up against a bladder that had scar tissue removal one month earlier.

Radiodec

[radiodec]

Well, I am through surgery and in very good shape minimal discomfort with lots to report.

Scar tissue, loads of it, don't have particulars yet. Surgery that was scheduled to take 1.5 hours took 2.5 hours. I now have what you would call an ectopic placement of the reservoir. It is on the right and above, get more data when talk to urologist. Very lille pain or discomfort, most pain from any stretching pressure against alternate placement area. Alternate placement caused by scar tissue for ancient undescended left testicle repair and concurrent hernia repair under location of testicle in canal.


The surgery went well other than being long, the most pain was froma catheter that would lose drain all the time and back up against a bladder that had scar tissue removal one month earlier.

Radiodec