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

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.