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High-submuscular vs. space of Retzius reservoir placement during implantation of inflatable penile implants

International Journal of Impotence Research volume 32, pages 18–23 (2020)Cite this article

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Abstract

We have evaluated the data of patients who underwent ectopic high submuscular reservoir placement during implantation of inflatable penile prostheses and compared them to those of patients who underwent to traditional reservoir placement in the space of Retzius (SR). The main focus was on evaluating complications and patient satisfaction rates in both methods of RP. One hundred and forty-two patients underwent implantation of the Coloplast Titan OTR prosthesis with exclusive use of the “Clover Leaf” reservoir. We performed a retrospective evaluation, analyzing the treatment-associated complications by means of the Clavien–Dindo classification. All patients as well as their partners received questionnaires with validated scores. Group I: 70 (49.3%) patients who underwent HSM RP. Group II: 72 (50.7%) patients who underwent SR RP. Neither grade IV nor grade V Clavien–Dindo complications were documented. In total, we observed 4 (3.3%) cases grade III b complications, which resulted in revision. Distribution was as follows: infected device (n = 4), scrotal hematoma (n = 2), scrotal seroma (n = 1), and scrotal skin fistula (n = 1). 88% of the patients with ectopic HSM RP and 81% with traditional SR RP were satisfied with their implant. Of the patients with HSM RP, 64.3% (n = 45; BMI range: 18.5–28.8) reported that they were able to feel their reservoir by palpation immediately after surgery. Palpability disappeared in 80% of the patients in this group (BMI > 26.5) after capsule formation at 3 months post-surgery. Only one patient (1.4%; BMI 20.5) reported that he was able to see the reservoir. Our findings suggest that the novel reservoir placement is safe, efficient and results in excellent patient satisfaction, even if the reservoir is initially palpable or visible.

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References

  1. Goldstein I, Newman L, Baum N, Brooks M, Chaikin L, Goldberg K, et al. Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment. J Urol. 1997;157:833–9.

    Article  CAS  Google Scholar 

  2. Porena M, Mearini L, Mearini E, Marzi M, Zucchi A. Penile prosthesis implantation and couple’s satisfaction. Urol Int. 1999;63:185–7.

    Article  CAS  Google Scholar 

  3. Natali A, Olianas R, Fisch M. Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany. J Sex Med. 2008;5:1503–12.

    Article  Google Scholar 

  4. Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol. 2000;37:50–5.

    Article  CAS  Google Scholar 

  5. Levine LA, Hoeh MP. Review of penile prosthetic reservoir: complications and presentation of a modified reservoir placement technique. J Sex Med. 2012;9:2759–69.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Henry G, Hsiao W, Karpman E, Bella AJ, Carrion R, Jones L, et al. A guide for inflatable penile prosthesis reservoir placement: pertinent anatomical measurements of the retropubic space. J Sex Med. 2014;11:273–8.

    Article  Google Scholar 

  8. Perito P, Wilson SK. History of non-traditional or ectopic placement of reservoirs in prosthetic urology. Sex Med Rev. 2016;4:190–3.

    Article  Google Scholar 

  9. Wilson SK, Delk JR 2nd. Ectopic placement of AMS 800 urinary control system pressure-regulating balloon. Urology. 2005;65(Jan):167–70.

    Article  CAS  Google Scholar 

  10. Wilson SK, Henry GD, Delk JR Jr, Cleves MA. 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.

    Article  Google Scholar 

  11. Perito PE, Wilson SK. Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement. J Sex Med. 2011;8:656–9.

    Article  Google Scholar 

  12. Stember DS, Garber BB, Perito PE. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. Henry GD, Karpman E, Brant W, Christine B, Kansas BT, Khera M, et al. The who, how and what of real-world penile implantation in 2015: the PROPPER registry baseline data. J Urol. 2016;195:427–33.

    Article  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications. Five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  16. Althof SE, Corty EW, Levine SB, Levine F, Burnett AL, McVary K, et al. EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction. Urology. 1999;53:793–9.

    Article  CAS  Google Scholar 

  17. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.

    Article  CAS  Google Scholar 

  18. Tausch TJ, Morey AF, Zhao LC, Knoll P, Simhan J, Scott JF, et al. High submuscular versus space of Retzius placement of inflatable penile prosthesis reservoirs: results of a surgeon survey. Can J Urol. 2014;21:7465–9.

    PubMed  Google Scholar 

  19. 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;84:1535–40.

    Article  Google Scholar 

  20. Pagliara TJ, Viers BR, Scott J, Morey AF. Extended experience with high submuscular placement of urological prosthetic balloons and reservoirs: refined technique for optimal outcomes. Urol Pract. 2018;5:293–8.

    Article  Google Scholar 

  21. Singla N, Siegel JA, Simhan J, Tausch TJ, Klein A, Thoreson GR, et al. Does pressure regulating balloon location make a difference in functional outcomes of artificial urinary sphincter? J Urol. 2015;194:202–6.

    Article  Google Scholar 

  22. Garber BB, Bickell M. Subcutaneous placement of inflatable penile prosthesis reservoirs. Urology. 2016;88:93–6.

    Article  Google Scholar 

  23. Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. 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.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Dr Steven K. Wilson for editing the paper and for providing an illustration from his collection. We would like to thank Mrs Kalz for professional work with an English text.

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Authors and Affiliations

  1. Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

    D. Osmonov, A. Chomicz, K. M. Arndt & K. P. Jünemann

  2. Hamburg University of Applied Sciences, Hamburg, Germany

    M. Tropmann-Frick

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  1. D. Osmonov
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  2. A. Chomicz
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  3. M. Tropmann-Frick
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  4. K. M. Arndt
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Correspondence to D. Osmonov.

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Osmonov, D., Chomicz, A., Tropmann-Frick, M. et al. High-submuscular vs. space of Retzius reservoir placement during implantation of inflatable penile implants. Int J Impot Res 32, 18–23 (2020). https://doi.org/10.1038/s41443-019-0201-4

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