Abstract
Multiple-component inflatable penile prostheses (IPPs) consist of paired intracorporal cylinders, a scrotal pump, and an abdominal fluid reservoir. In recent years, ectopic (e.g., non-space of Retzius) reservoir insertion techniques have become more popular among implanting urologists. The aim of this study was to describe our technique of sub-external oblique (SEO) placement of IPP reservoirs, and to review our initial experience with this technique. We carried out a retrospective review of the first 50 patients who underwent insertion of a Coloplast Titan® IPP via a scrotal incision, employing a newly developed SEO reservoir insertion technique. All procedures were carried out by a single high-volume surgeon (BBG), and retrospective chart review was carried out. Patients were seen and evaluated on the first post-operative day, then at 2 weeks, 6 weeks, as needed, and periodically thereafter. All 50 patients were available for short-term post-operative follow-up (average 6.6 months, range 3–12 months). The SEO technique was only used if there was no prior inguinal canal surgery, and no evidence of an inguinal hernia. The SEO technique was easy to carry out, and there were no instances of bowel, bladder, blood vessel, nerve, or spermatic cord injury. There were also no cases of reservoir herniation, intraperitoneal insertion, or reservoir visibility. One patient had prolonged pain (4 weeks) related to the reservoir; however, this completely resolved after treatment with non-steroidal analgesics. In asthenic patients, the reservoir could be detected with deep, careful palpation. However, no patients have required or requested IPP revision or removal to date. With short-term follow-up, we found that SEO reservoir insertion has been an easily-performed and safe option for ectopic reservoir insertion. The SEO method has avoided the infrequent but severe complications seen with previously described reservoir insertion techniques. Longer duration of follow-up, and trials by other implanting urologists, will be required to confirm or refute these initial promising results.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Garber BB, Morris A. Intravesical penile implant reservoir: case report, literature review, and strategies for prevention. Int J Impot Res. 2012;25:41–4.
Levine L, Hoeh M. Review of penile prosthetic reservoir: complications and presentation of a modified reservoir placement technique. J Sex Med. 2012;9:2759–69.
Wilson S, Henry G, Delk J, Cleves M. The Mentor alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement. J Urol. 2002;168:1475–8.
Perito P. Ectopic reservoir placement-no longer in the space of Retzius. J Sex Med. 2011;8:2395–8.
Perito P, Wilson S. Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement. J Sex Med. 2011;8:656–9.
Morey AF, Cefalu CA, Hudak SJ. High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013;10:603–10.
Chung PH, Morey AF, Tausch TJ, Simhan J, Scott JF. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology. 2014;84:1540–5.
Pagliara TJ, Viers BR, Scott J, Morey AF. Extended experience with high submuscular placement of urologic prosthetic balloons and reservoirs: refined technique for optimal outcomes. Urol Pract. 2018;5:293–8.
Stember D, Garber B, Perito P. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. J Sex Med. 2014;11:605–12.
Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey A. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med. 2013;10:2115–20.
Karpman E, Brant WO, Kansas B, Bella AJ, Jones LA, Eisenhart E, et al. Reservoir alternate surgical implantation technique: preliminary outcomes of initial PROPPER study of low profile or spherical reservoir implantation in submuscular location or traditional prevesical space. J Urol. 2015;193:239–44.
Reznicek D, Bryson R, Kramer A. Review: alternative placement of penile prosthesis reservoir and AUS pressure regulating balloon. Sex Med Rev. 2015;3:48–55.
Smaldone M, Cannon G, Benoit M. Subcutaneous reservoir placement during penile prosthesis implantation. Can J Urol. 2006;13:3351–2.
Garber BB, Bickell M. Subcutaneous placement of inflatable penile prosthesis reservoirs. Urology. 2016;88:93–6.
Ziegelmann MJ, Viers BR, Lomas DJ, Westerman ME, Trost LW. Ectopic penile prosthesis reservoir placement: an anatomic cadaver model of the high submuscular technique. J Sex Med. 2016;13:1425–31.
Condon RE. The anatomy of the inguinal region and its relation to groin hernia. In: Nyhus LM, Condon RE, editors. Hernia, 4th ed. J.B. Lippincott Co.; Philadelphia, PA, USA. 1995. p. 35.
Hinman F. Atlas of urosurgical anatomy. W.B. Saunders Co.; Philadelphia, PA USA. 1993. p. 172–3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Garber, B.B., Gross, M.S. & Stember, D. Sub-external oblique placement of inflatable penile prosthesis reservoirs—initial experience. Int J Impot Res 31, 400–403 (2019). https://doi.org/10.1038/s41443-018-0101-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-018-0101-z
This article is cited by
-
State of the Reservoir: Current Concepts of Penile Implant Reservoir Placement and Potential Complications
Current Urology Reports (2021)