Robotic-assisted laparoscopic radical prostatectomy (RALP) is the standard of care for prostate cancer. A small subset of the population may have penile prostheses co-existing due to presurgical evaluation and treatment for erectile dysfunction. RALP becomes a surgical challenge due to the existing prosthesis and reservoir. In this video, we share our experience with a patient with a double reservoir, which is partially deflatable.

The steps and technique in RALP by preserving the penile prosthesis reservoir.

Video Clip:
Step 1: Preservation of pseudo capsule around the penile prosthesis reservoir
During the bladder drop, the penile prosthesis reservoirs were identified. The bladder was dropped after adequate dissection and lateralization of the partially deflatable penile prosthesis reservoir, preserving the pseudo capsule around it. This helps avoid inadvertent injury to the reservoir. 

Step 2: Realignment of the instrumental and camera arm 
After adequate dissection and lateralization of the reservoir, the instrumental and the camera arm were medially realigned and burped down to avoid injury to the reservoir. Precision in surgery with fine movements and by restricting the range of instrumental arm movement with regular visualization is crucial.

RALP in a penile prosthesis patient with a partially deflatable double reservoir is a surgical challenge. Preserving the pseudo-capsule during the dissection of the reservoir could help. To avoid injury. Due to limited tactile feedback, medial realignment of the instrumental arm and burping down the camera could be helpful. Precision in surgical steps and limiting the range of operative arm movement could avoid injury to the reservoir. In some situations, penile prosthesis removal could be considered.