Review of techniques and approaches for ectopic reservoir placement in inflatable penile implant

Inflatable penile prosthesis (IPP) implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy. The standard placement of the reservoir in the space of Retzius (SOR) may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications. This has led to the development of alternative ectopic reservoir placement techniques. In this narrative review, we summarize the literature on various ectopic reservoir approaches, including low and high submuscular placements, submuscular techniques with counter incisions or transfascial fixation, midline submuscular placement, subcutaneous placement, and lateral retroperitoneal approaches. We describe the surgical methods, outcomes, and complication rates associated with each technique. While most methods demonstrate low complication and revision rates, direct comparisons remain limited due to heterogeneity and lack of prospective data. This review highlights the importance of individualized technique selection based on prior surgical history, body habitus, and surgeon experience. As ectopic placement becomes more widely adopted, familiarity with multiple approaches is essential for prosthetic surgeons.