Abstract: PD22-05
Sources of Funding: none

Introduction

Since 2011, we have routinely placed urologic prosthetic balloons and reservoirs (UPBRs) in a high submuscular (HSM) location during inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) surgery. The HSM technique involves blunt dissection through the external inguinal ring to position the device in a pocket between the transversalis fascia and rectus abdominis muscle. Here we review our experience of over 500 HSM cases to compare complication rates to a prior series of Space of Retzius (SOR) cases and to describe our refined HSM technique to prevent reoperation.

Methods

A retrospective review was performed of patients who underwent inflatable penile prosthesis and/or artificial urinary sphincter placement between January 2009 and April 2016. Complications, intraoperative consults, and need for revision were recorded and compared between both placement modalities (HSM vs RP).

Results

During the study period, 815 prosthetic implants and revisions were performed, including 527 HSM cases (IPP reservoirs, n= 292; AUS balloons, n= 235). Total implant revisions across the HSM time period occurred in 64 patients (12.3%), of which only 1.5% (N=8) were attributable to the UPBR. Most common reasons for reoperation were "pain or bother" (n=4) or herniation (n=4). UPBRs placed in the SOR had a similar rate of herniation at 1% (n=3) from 2009-2011 but higher rate of deep pelvic complications compared to HSM cases (Table 1); however, no deep pelvic complications have occurred in the past 390 HSM cases since deploying our refined technique.

Conclusions

Further experience with HSM placement of UPBR confirms that it is well tolerated, with rare complications that are usually minor in nature. Compared to the SOR approach, the complication rates for UPBRs appear similar in frequency but potentially less catastrophic, with a lower risk to bladder or vascular structures. Our refined technique appears to further reduce risk of complications seen early in our experience.

Funding

none