Sub-external oblique placement of inflatable penile prosthesis reservoirs—initial experience

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.