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Reservoir migration in inflatable penile prostheses: a systematic review and development of a clinical decision algorithm

International Journal of Impotence Research (2025)Cite this article

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Abstract

The three-piece inflatable penile prosthesis (IPP) offers durable functional outcomes for men with medication-refractory erectile dysfunction. While rare, IPP reservoir migration can be significant. This systematic review aims to characterize the incidence of reservoir migration, assess migration outcomes across various placement techniques, and propose a clinical decision-making algorithm for reservoir placement. A comprehensive search of PubMed and the Cochrane Library was conducted on April 7, 2025, without filters. Eligible English-language studies reporting migration-related outcomes of functional IPP reservoirs were included. Data extraction and risk-of-bias assessments were performed using validated tools. Thirty-five studies were included: 19 case reports, 10 case series, and 6 cohort studies. A meta-analysis of proportions using a random-effects model was performed on 9 case series and 6 cohort studies (5783 patients), yielding a pooled migration rate of 0.2% (95% CI: 0.0%–0.6%) with moderate heterogeneity (I² = 54.2%). Sensitivity analyses yielded consistent results. The evidence is limited by small sample sizes, retrospective designs, and reporting variability. Migration risk is low but clinically significant and especially relevant in patients with altered pelvic anatomy. Based on findings, we propose a clinical algorithm incorporating patient risk factors to guide reservoir placement decisions.

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Fig. 1: PRISMA flow diagram illustrating the study selection process.
Fig. 2: Forest plot of the pooled proportion of reservoir migration across included case series and cohort studies.
Fig. 3: Risk-stratified algorithm for IPP reservoir placement.
Fig. 4: Surgical steps of the author’s preferred reservoir placement technique.

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Data availability

All data generated or analyzed during this study are included in this published article. Extracted data from included studies, data collection forms, and any analytic materials are available from the corresponding author on reasonable request. The review was not registered and a review protocol was not prepared.

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Authors and Affiliations

  1. Department of Urology, Holmesglen Private Hospital, Moorabbin, VIC, Australia

    Erin Curran & Christopher Love

  2. Sexual Medicine, Male Infertility and Andrology Fellow, Melbourne, VIC, Australia

    Erin Curran

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  1. Erin Curran
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  2. Christopher Love
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Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results: CL, EC. Drafted or revised the manuscript: EC. Approved the final version: CL, EC. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: CL, EC

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Correspondence to Erin Curran.

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Curran, E., Love, C. Reservoir migration in inflatable penile prostheses: a systematic review and development of a clinical decision algorithm. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01139-x

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