Penile prosthesis reservoir – an imaging pitfall

Gender-affirming surgical techniques, complications, and imaging considerations for the abdominal radiologist

Gender-affirming surgery is a group of surgical procedures that alters the physical appearance of a transgender person to resemble that socially associated with their identified gender. Masculinization and feminization surgeries include chest and breast surgery as well as genital reconstruction. The genital reconstruction surgeries have unique anatomic imaging features and are associated with complications that may require radiologic evaluation. This review provides a review of the imaging anatomy, expected findings, and complications associated with gender-affirming surgeries.

Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses

OBJECTIVE

To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants.

CONCLUSION

Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

A catalog of magnetic resonance imaging compatibility of penile prostheses

INTRODUCTION

Erectile dysfunction has been successfully treated with penile prosthesis implantation for over 50 years. Ferromagnetic implants or devices may create a potentially hazardous or painful situation during magnetic resonance imaging (MRI). A modern catalog of the MRI compatibility of penile prostheses is not available.

AIM

Evaluate the safety profile of implanted, penile prostheses during MRI.

MAIN OUTCOME MEASURE

Review available in vitro safety data and reported patient complications experienced during MRI with a penile prosthesis in place.

METHODS

A search of PubMed™ for articles documenting a penile prosthesis present during MRI was performed. Radiology texts and product information from manufacturers' producing a penile prosthesis were reviewed. Direct discussion with product manufacturers was also performed to obtain additional safety and compatibility information.

RESULTS

Nine clinical articles noted the presence of a penile prosthesis at the time of magnetic resonance imaging. No articles documented a complication from MRI of a man with a penile prosthesis. A single patient with an unnamed malleable prosthesis was noted to have twisting of the device during MRI which did not result in discomfort or malfunction of the device. In vitro studies support the safety of most prostheses during MRI.

CONCLUSION

The available data suggests there is little risk for most patients with a penile prosthesis who undergo MRI. Notable exceptions include Dacomed's Omniphase and Duraphase device and the MRI-conditional Spectra device manufactured by AMS. Current manufacturers of penile implants provide wallet cards and medical letters to support safety when undergoing an MRI. Prior prosthesis implantation should not preclude patients from having an MRI.

Abdominoplasty in patient with penile implant

BACKGROUND

In the United States, one third of adult men are obese (BMI > 30 kg/m²) and profound sexual dysfunction is quite common in them. Penile prostheses have proved to be an effective and widespread therapeutic option, with approximately 30,000 devices implanted annually worldwide.

METHODS

A 54-year-old weight-loss male patient came to our practice for body contouring. Upon admission we discovered the presence of a three-piece inflatable prosthesis, placed many years before.

RESULTS

We decided to perform an abdominoplasty plus pubic lift supported by ultrasound in order to better localize the implant reservoir, to exclude tractions or distortions of the connecting system or pump damage, and also to locate and draw the corresponding new position of the reservoir and the pump on the skin.

CONCLUSION

Our case reminded us that we should always suspect the presence of penile prostheses in bariatric patients in order to avoid intraoperative damage and subsequent medicolegal problems. Their precise detection is crucial and ultrasound is a safe, inexpensive, and useful method for accurate pre-, intra-, and postoperative localization of genital prostheses.