The Low Submuscular Reservoir Placement with Transfascial Fixation for Inflatable Penile Prostheses

Abstract

Background Several techniques have been described for placement of inflatable penile prostheses (IPP) reservoirs, with variable satisfaction. Standard placement in the Space of Retzius can present with several complications and may be technically difficult in patients with a violated space. Concerns with ectopic reservoir placement have included reservoir herniation and lack of reservoir concealability. Aim To present a novel technique to achieve reservoir concealment with decreased postoperative complications as an alternative to standard approaches of ectopic reservoir placement. Methods We describe our novel low submuscular reservoir (LSM) placement with transfascial fixation (TFF) for inflatable penile prostheses. Outcomes Patient satisfaction with reservoir concealment, complication rate or need for additional surgeries. Results A total of 31 cases successfully underwent our technique. The low submuscular placement with TFF of the IPP reservoir offers an optimal approach for reservoir placement with a high degree of patient satisfaction with significant ease of placement compared to alternative methods. Clinical Implications Penile prosthetic surgeons should be familiar with several techniques for concealment of reservoir as an option to improve patient satisfaction. Strengths and Limitations Given the small sample size of patients who have undergone this novel technique, current literature regarding the topic is limited. Conclusion Low submuscular reservoir placement with transfascial fixation for IPPs is a technically feasible approach that can be employed to achieve patient satisfaction and decrease the risk of reservoir herniation.

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“…Alternative reservoir placements may be considered, including high or low submuscular, with or without the use of a counter incision. [80][81][82] While IPP placement is typically safe, intraoperative complications that can occur are proximal corporal perforation; distal corporal perforation; urethral injury; corporal crossover; and bowel, bladder, or vascular injury. 83 Postoperatively, complications that can occur are reservoir herniation, reservoir erosion, auto-inflation, implant infection, mechanical failure, hematoma, and venous compression syndrome, although the incidence of these complications is quite low.…”

“…However, in the case of prior violation of the SoR, reservoir placement in that location increases the risk of bladder injury. Alternative reservoir placements may be considered, including high or low submuscular, with or without the use of a counter incision 80–82 …”