Insertion of three-piece inflatable penile prosthesis (IPP) after radical cystectomy and ileal substitution is known to increase the risk of bowel perforation or herniation. Recent research indicates that transfascial submuscular placement of the reservoir through a high inguinal incision reduces this risk. This study assessed the feasibility and safety of this surgical technique.

From January 2020 to December 2024, patients at our hospital who underwent penile prosthesis insertion surgery for medication-refractory erectile dysfunction after radical cystectomy and ileal neobladder surgery were eligible for this study. Patients who received a malleable penile prosthesis were excluded. The outcomes, including the presence of infection and the need for reoperation, were evaluated immediately after surgery and during follow-up.

Thirteen patients underwent three-piece IPP insertion surgery after radical cystectomy and ileal substitution. The median age at surgery was 65.5 years (IQR: 59.7–74.2) The median interval from radical cystectomy to IPP surgery was 22 months (IQR: 15.5–31). Three cases received replacement surgeries due to mechanical failure of previously inserted IPP pumps. All surgeries performed inserting the cylinder and pump through a penoscrotal incision under general anesthesia, followed by an additional incision in the left high inguinal area to place the reservoir in the transfascial submuscular area just lateral to rectus muscle. There were no immediate postoperative complications, and pump operation was problem-free. During a median follow-up of 21 months (IQR: 7–28), no wound infections or mechanical problems were reported. However, three patients experienced urinary tract infections, associated with relatively high residual urine volume. One patient was treated by explanation of prosthesis 9 months after implantation due to recurrent pyelonephritis.

The three-piece IPP with transfascial high inguinal reservoir placement is a safe and feasible surgical method that can be performed in patients with radical cystectomy and ileal substitution. However, we should pay attention to the change of voiding patter especially for increasing residual urine after penile prosthesis implantation.