High Sub-Rectus Reservoir Placement: A Practical Solution for Penile Prosthesis Surgery in Patients with Complex Pelvic Anatomy

O. Canguven, K. Al Kubaisi

Complex Pelvic Anatomy, Penile prosthesis, Reservoir, Sub-rectus space

This video abstract presents high sub-rectus reservoir placement as a safe and reliable alternative during inflatable penile prosthesis implantation in patients with hostile pelvic anatomy. The case involves a middle-aged man with severe prior pelvic trauma, including bilateral pubic ramus fractures, pubic diastasis, internal iliac artery embolization, exploratory laparotomy, sigmoid colostomy, and posterior urethral rupture. After staged urethral reconstruction, a three-piece IPP was implanted, with the reservoir positioned in the high sub-rectus plane between the rectus abdominis muscle and posterior rectus sheath. Stepwise video guidance highlights anatomical landmarks, technical refinements, and tips to avoid complications. The procedure was completed successfully, with secure reservoir placement and standard prosthesis function. This approach offers a safe, effective option for patients in whom traditional retropubic placement is contraindicated.

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