High Submuscular Placement of Urologic Prosthetic Balloons and Reservoirs via Transscrotal Approach

Abstract

Introduction Traditional placement of inflatable penile prosthesis (IPP) reservoirs and/or artificial urinary sphincter (AUS) balloons into the space of Retzius may be challenging following major pelvic surgery. Aim The aim of this study is to report our 1-year experience using a novel technique for high balloon/reservoir placement beneath the rectus abdominus muscle, thus completely obviating deep pelvic dissection during prosthetic urologic surgery. Methods A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and June 2012 was performed. All had AUS balloons and/or IPP reservoirs placed in a submuscular location by bluntly tunneling through the external inguinal ring into a potential space between the transversalis fascia and the rectus abdominus muscle using a long, angled, lung grasping clamp. Main Outcome Measures Patient demographics, perioperative outcomes, and initial follow-up patient-reported outcomes were reviewed. Results During the study period, 120 submuscular balloons/reservoirs were inserted in 107 consecutive patients who underwent placement of an IPP (61 patients), AUS (33 patients), or both (13 patients). Among our 48 most recent patients, 41 (85%) reported they were totally unable to feel their balloon/reservoir, and all but two patients reported no bother from the submuscular balloon/reservoir placement. Of the 120 total submuscular balloons and reservoirs, surgical time and outcomes of the prosthetic procedures appeared similar to those placed using traditional methods; two reservoirs required revision surgery for repositioning. Conclusions High submuscular placement of genitourinary prosthetic balloons and reservoirs via a transscrotal approach is both safely and effective, while avoiding deep retropubic dissection.

The Prevention and Management of Noninfectious Complications of Penile Implants

“…When a reservoir is placed in the inguinal ring through the transversalis fascia and into the Space of Retzius, and filled with fluid, it may compress the bowel and obstruct it, necessitating exploration and lysis of adhesions [14]. To avoid this complication in these circumstances, it is recommended that the reservoir be placed ectopically between the transversalis fascia below and the transversus abdominis muscle above [15]. To accomplish this, the index finger is placed through the external inguinal ring on top of the transversalis fascia, and a space is created below the muscle layers pointing to the ipsilateral shoulder.…”

The Evolution of the Inflatable Penile Prosthesis Reservoir and Surgical Placement

“…A potential downside to ectopic placement include reservoir palpability is more likely to occur in slender patients. This occurred in the series in 15 patients (3.4%); however, only two desired corrective surgery [13].…”

“…In an effort to decrease the rates of hernia formation and palpability, Dr. Morey introduced a high submuscular approach [13]. Chunge et al.…”

Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon

“…Outcomes from Morey et al show that 7/48 (15%) patients are able to palpate their submuscular reservoir; however, no patients report being significantly bothered [11].…”