V1582: HIGH SUBMUSCULAR PLACEMENT OF UROLOGIC PROSTHETIC BALLOONS AND RESERVOIRS VIA TRANS-SCROTAL APPROACH
VideoIntroduction and Objectives
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. The aim of this study is to report our one 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.
A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and September 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. Patient demographics, perioperative outcomes, and follow up patient reported outcomes were reviewed.
During the study period, 170 submuscular balloons/reservoirs were inserted in 157 consecutive patients who underwent placement of an IPP (111 patients), AUS (33 patients), or both (13 patients). Among our 71 most recent patients who completed the follow-up questionnaire, 61 (86%) reported they were totally unable to feel their balloon/reservoir, and all but 2 (97%) reported no bother from the submuscular balloon/reservoir placement. Overall satisfaction was high with 70% of patients stating that they were “delighted” with their implant. The prosthetic balloon or reservoir was not palpable or minimally palpable to the surgeon on follow-up in 97% of patients. Of the 170 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.
High submuscular placement of genitourinary prosthetic balloons and reservoirs via a trans-scrotal approach is both safe and effective, while avoiding deep retropubic dissection.