A Modified Surgical Technique for Reservoir Placement During Inflatable Penile Prosthesis Implantation

Abstract

Introduction At the moment, there is an ongoing debate regarding the controversial issue of the ideal reservoir placement (RP) surgical technique during implantation of a 3-piece inflatable penile prosthesis, but a definitive winner has not yet emerged. Aim In this light, we herein describe our modified technique for RP into the space of Retzius through the external oblique muscle fascia and present its results. Methods In total, 253 inflatable penile prosthesis procedures (110 AMS 700 and 143 Coloplast Titan) via a single transverse penoscrotal incision were retrospectively reviewed. 2 Kocher-Langenbeck retractors were placed over the right side of the penoscrotal incision and were used to retract the incision superior to the pubic bone. Then, the external oblique muscle fascia was incised medially to the spermatic cord which was retracted laterally. Next, a “W”, Vicryl 1, stay suture was placed to the incision, and under direct visualization, external oblique muscle fibers were dissected and fascia transversalis was perforated using a Metzenbaum scissor. A Foerster lung grasping clamp was then used to dissect further into the extraperitoneal space and create the reservoir space. The reservoir was placed into the created space and fascia incision was closed using the prepositioned stay suture. The procedure was then completed in a standard fashion. Outcomes The main outcome measures were intraoperative or postoperative complications of our modified RP technique. Results All 253 patients were available for short-term follow-up (average 9.1 months, range 3–22 months). No intraoperative or postoperative complications were reported. Reservoir-related prolonged pain (1 month) was reported by 1 patient, resolving completely after treatment with non-steroidal analgesics. Conclusion We are, surely, not proposing that our modified RP technique should supplant all other methods; rather, it should be considered another useful option for RP in the implanter’s armamentarium. Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inatable Penile Prosthesis Implantation. Sex Med 2020;8:378–382.

Midline submuscular penile prosthesis reservoir placement for patients with bilateral inaccessible inguinal rings: technique and outcomes

“…This is an easily reproducible technique as the fascia can be visualized medially by lateral retraction of the spermatic cord and punctured with Metzenbaum scissors. 15 This technique depends on access to the SOR which might be violated in patients after radical prostatectomy or cystectomy.…”

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study

“…Many studies have presented different approaches (penoscrotal, infrapubic, or subcoronal) regarding accessing the corporal bodies during IPP surgery [13][14][15]. Moreover, the serious reservoir placement-related complications and increased application of surgical approaches, which compromise the space of Retzius, led prosthetic urologists to introduce innovative Retzius sparing reservoir placement techniques [16][17][18].…”

“…Moreover, RTEs were developed in 1981 and quickly became popular among implanters as a measure to minimize friction of the tubing against the cylinder wall. The reported high RTE use rate, from 58% up to 73%, during IPP surgeries suggests that this innovation gave surgeons flexibility 13.5 (12)(13)(14)(15) in placement of corporotomies and minimization of intracorporeal tubing [16]. However, it has separately reported that RTE utilization be kept to a minimum.…”

Penile prosthesis in the medically complex patient: a narrative review

“…Placement in this space avoids intra-abdominal complications and allows a low-pressure space for the reservoir ( 40 ). Access could be obtained through a separate suprapubic incision or in the same—e.g., in the penoscrotal approach—incision via the inguinal canal or the external oblique muscle fascia ( 41 ). The fascia transversalis could be perforated with the finger, sharp or with a nasal speculum ( 42 - 44 ).…”

“…Due to previous surgery—such as radical prostatectomy, radical cystectomy or colorectal surgery—the Retzius space could be compromised which could result in a higher risk of complication, e.g., damage to iliac vessels, bladder or intestines ( 41 ).…”