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Wright NM, Applewhite JP, Reddy AG, Khera M. Advancements in ectopic reservoir placement for inflatable penile prostheses. Sex Med Rev 2024:qeae046. [PMID: 39003088 DOI: 10.1093/sxmrev/qeae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Traditional reservoir placement (RP) into the space of Retzius during three-piece inflatable penile prosthesis implantation has been associated with serious bladder, iliac vessel, and bowel complications, encouraging the development of "ectopic" RP methods. OBJECTIVES In this study we sought to document an up-to-date, comprehensive analysis of ectopic RP techniques regarding both patient satisfaction and clinical complications. METHODS A PubMed, Ovid MEDLINE, and Cochrane Library literature search of English language articles from 1966 to 2023 with keywords "inflatable," "penile prosthesis," "reservoir," and "placement" gave 179 publications, 70 of which were included in a comprehensive chronology and investigation after review. Overall, 12 retrospective studies detailing 9 ectopic RP techniques were compared for discussion. RESULTS Sufficient data for comparison were found for 9 ectopic RP methods: posterior/anterior to transversalis fascia (PTF/ATF); high submuscular (HSM); HSM "Five-Step" technique (HSM-FST); lateral retroperitoneal (LR); sub-external oblique (SEO); direct vision, transfascial (DVT); low submuscular with transfascial fixation (LSM w/ TFF); and midline submuscular reservoir (MSMR). Although rare, serious complications have occurred with the use of ectopic RP techniques: 2 bladder perforations on implantation with PTF RP, a delayed bowel obstruction with HSM RP, and a colonic injury in a patient with a history of colon surgery with LR RP. Generally, herniation is the most relevant clinical complication in ectopic RP. At the time of this review there was no reported herniation with LR, SEO, LSM w/ TFF, or MSMR, likely due to fixation steps and/or reinforced spaces. Regarding patient satisfaction, HSM, HSM-FST, and LSM w/ TFF had similarly high rates of patient satisfaction while other techniques had no patient satisfaction data available. Importantly, reservoir palpability/visibility relates directly to patient satisfaction. Levels of palpability and/or visibility were reported in patients who underwent PTF/ATF, HSM, HSM-FST, SEO, and LSM w/ TFF, whereas no palpability was reported in patients who underwent LR, DVT, and MSMR. CONCLUSION Proper comparison of ectopic methods is not possible without standardized patient surveys, consistent complication reporting, and larger sample sizes, indicating the need for a large, prospective, multisurgeon trial.
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Affiliation(s)
- Nicole M Wright
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - James P Applewhite
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Amit G Reddy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
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Markarian E, Boyd SD, Ginsberg D, Loh-Doyle J. Immediate and Long-term Outcomes of Lateral Retroperitoneal Pressure Regulating Balloon Placement During Artificial Urinary Sphincter Implantation. Urology 2024; 183:250-255. [PMID: 37926382 DOI: 10.1016/j.urology.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To describe immediate and long-term outcomes of pressure regulating balloon (PRB) placement, exchange, and extraction from the lateral retroperitoneum (LR) in male patients receiving an artificial urinary sphincter (AUS). METHODS A retrospective chart review was performed on all patients that underwent primary AUS placement between 2006 and 2021. All patients had the PRB placed in the LR during the study period. Intraoperative complications during PRB placement, exchange, or removal, and indications for PRB revision, such as infection, erosion, or mechanical failures were analyzed. RESULTS Five hundred forty-one patients were included in the study. All patients underwent primary implantation with no intraoperative complications including no incidents of bowel or vascular injury during PRB placement. In addition, there were no instances of intraoperative injury during PRB removal (with or without PRB replacement). After mean follow-up of 54.8months (range: 1-181months), 9 patients (1.7%) developed a reservoir-specific complication with infection (5 patients, 0.9%) being the most common issue found. The second most common type or reservoir issue was a palpable or herniated reservoir. There were 2 patients (0.4%) who herniated their reservoirs and one patient with a nonbothersome, but palpable reservoir. Lastly, there were 2 incidents (0.4%) of mechanical failure caused by a leak in the PRB. CONCLUSION Due to the ease and safety of placing and removing PRBs from this location and exceedingly low rates of PRB-related complications in long-term follow-up, the LR should be considered as an ideal location for PRB placement in male patients receiving an AUS.
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Affiliation(s)
- Emily Markarian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart D Boyd
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David Ginsberg
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey Loh-Doyle
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Tua-Caraccia RD, Adams ES, Watters CR, Lentz AC. Management of urologic prosthetic reservoirs at the time of inguinal or pelvic surgery. Sex Med Rev 2023; 11:431-440. [PMID: 37200135 DOI: 10.1093/sxmrev/qead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic regions. Because of this, patients with urologic prosthetics sometimes present challenges during future nonprosthetic operations. Presently, there is no established guideline for device management with ensuing inguinal or pelvic surgery. AIMS This article outlines concerns during pelvic and inguinal surgery for patients with an artificial urinary sphincter and/or inflatable penile prosthesis and proposes an algorithm for preoperative surgical planning and decision making. METHODS We conducted a narrative review of the literature on operative management of these prosthetic devices. Publications were identified by searching electronic databases. Only peer-reviewed publications available in English were considered for this review. RESULTS We review the important considerations as well as available options for operative management of these prosthetic devices during subsequent nonprosthetic surgery and highlight the advantages and disadvantages of each. Finally, we suggest a framework for helping surgeons determine which management strategy is most appropriate for their individual patients. CONCLUSION The best management strategy will differ depending on patient values, the planned surgery, and patient-specific factors. Surgeons should understand and counsel patients on all available options and encourage informed, shared decision making to determine the best individualized approach.
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Affiliation(s)
- Rafael D Tua-Caraccia
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Eric S Adams
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Christopher R Watters
- Section of General and Minimally Invasive Surgery, Division of Surgical Oncology, Department of Surgery, Duke General Surgery of Raleigh, Raleigh, NC 27609, United States
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
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Munoz-Lopez C, Lewis K, Dewitt-Foy M, Lone Z, Montague DK, Angermeier KW, Gill BC. Outcomes of Inflatable Penile Prosthesis following Radical Cystectomy - A matched Cohort Analysis. Urology 2023:S0090-4295(23)00144-9. [PMID: 36796542 DOI: 10.1016/j.urology.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To evaluate outcomes of inflatable-penile-prosthesis (IPP) implantation after radical-cystectomy compared with other etiologies of erectile dysfunction. MATERIALS AND METHODS All inflatable penile prostheses within the past 20 years in a large regional health system were reviewed, and erectile dysfunction etiology was determined as radical-cystectomy, radical-prostatectomy, or organic/other ED. Cohorts were generated by 1:3 propensity score match using age, body mass index, and diabetes status. Baseline demographics and relevant comorbidities were evaluated. Clavien-Dindo complications, grade, and reoperation were assessed. Multivariable logarithmic regression was used to identify the predictors of 90-day complications following IPP implantation. Log-rank analysis was used to assess the time-to-reoperation after IPP implantation in patients with a history of cystectomy compared with non-cystectomy etiologies. RESULTS Of 2600 patients, 231 subjects were included in the study. Comparing patients undergoing IPP for cystectomy vs. pooled non-cystectomy indications, those who underwent radical-cystectomy had a higher overall complication rate(24% vs. 9%, p=0.02). Clavien-Dindo complication grades did not differ across groups. Reoperation was significantly more common following cystectomy (cystectomy: 21% vs. non-cystectomy: 7%, p=0.01), however time to reoperation did not differ significantly by indication (cystectomy: 8 years vs non-cystectomy: 10 years, p=0.09). Among cystectomy patients, 85% of reoperations were due to mechanical failure. CONCLUSION Compared to other erectile dysfunction etiologies, patients undergoing IPP with a history of cystectomy have an increased risk of complications within 90-days of implantation and need for surgical device revision, but no greater risk for high-grade complications. Overall IPP remains a valid treatment option after cystectomy.
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Affiliation(s)
- Carlos Munoz-Lopez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Molly Dewitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Drogo K Montague
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Bradley C Gill
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Naughton A, Muheilan MM, Casey RG. Intra-abdominal migration of a penile prosthesis reservoir. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211039741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ailish Naughton
- Department of Urology, Tallaght University Hospital, Ireland
| | | | - Rowan G Casey
- Department of Urology, Tallaght University Hospital, Ireland
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Chen MZ, Keshava A. Hernia balloon? ANZ J Surg 2020; 91:1628-1629. [PMID: 33295109 DOI: 10.1111/ans.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Zhiyun Chen
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences Macquarie University, Sydney, New South Wales, Australia
| | - Anil Keshava
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences Macquarie University, Sydney, New South Wales, Australia.,Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Natali A, Grisanti Caroassai S, Tasso G, Cito G, Gemma L, Cocci A, Sessa F, Verrienti P, Serni S, Carini M, Delle Rose A. Intra-peritoneal versus retropubic implantation of three-piece inflatable penile prosthesis: Patient-reported outcomes and complications. Urologia 2020; 88:326-331. [PMID: 33094691 DOI: 10.1177/0391560320967876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The role of reservoir position was investigated in this series of patients treated with three-pieces penile prosthesis implantation (PPI). The outcomes and the patients' reported quality of life after insertion of the balloon in the retropubic space, or the Retzius's space (SOR), were compared with the outcomes of patients who received an intraperitoneal implantation (IP). The study aimed to analyze how the anatomy of the SOR influenced the long-term results of PPI, especially in patients who have been previously exposed to pelvic surgery or radiotherapy. The SOR has usually been identified as ideal for concealing and protecting the reservoir; nevertheless, an increasing rate of patients that ask for a PPI do not conserve the typical favorable characteristic of the SOR. In these cases, the tissue alteration can cause a higher rate of undesired events and can impair the satisfaction from device use. In the recent literature, few articles focus on the topic of reservoir position and very poor information is available about the results of the IP insertion. MATERIALS Our cohort of patients was retrospectively inspected; the two different subgroups, according to the reservoir position (SOR or IP) were evaluated considering the pre-operative condition, the post-operative complication, the development of undesired events or uncomfortable sensations during the follow-up. The quality of life after PPI was observed as well, with a questionnaire specifically developed for patients treated with PPI. The surgical technique adopted for the intraperitoneal implantation was described. RESULTS The results of penile prosthesis functionality and patients' and partners' reported quality of life (QoL) showed similar results between the two groups but greater satisfaction in the relational domain of the questionnaires adopted was described in the IP subgroup. CONCLUSION According to our observations, the IP reservoir insertion guarantees good functionality and lower rates of undesired events after PPI.
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Affiliation(s)
- Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Giovanni Tasso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Gemma
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pierangelo Verrienti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Augusto Delle Rose
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Khouri RK, Baumgarten AS, Ortiz NM, Ward EE, Baker RC, VanDyke ME, Yi YA, Hudak SJ, Morey AF. Pressure Regulating Balloon Herniation: A Correctable Cause of Artificial Urinary Sphincter Malfunction. Urology 2020; 139:188-192. [DOI: 10.1016/j.urology.2020.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/22/2023]
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Sub-external oblique placement of inflatable penile prosthesis reservoirs-initial experience. Int J Impot Res 2019; 31:400-403. [PMID: 30607003 DOI: 10.1038/s41443-018-0101-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 01/12/2023]
Abstract
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.
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Capoccia EM, Phelps JN, Levine LA. Modified Inflatable Penile Prosthesis Reservoir Placement Into Space of Retzius: Comparing Outcomes in Men With or Without Prior Pelvic Surgery. J Sex Med 2017; 14:968-973. [DOI: 10.1016/j.jsxm.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Subcutaneous Placement of Inflatable Penile Prosthesis Reservoirs. Urology 2015; 88:93-6. [PMID: 26655994 DOI: 10.1016/j.urology.2015.10.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/13/2015] [Accepted: 10/13/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review our experience with subcutaneous inflatable penile prosthesis reservoir insertion in a large, single-surgeon series. MATERIALS AND METHODS We carried out a retrospective review of 1000 consecutive Coloplast Titan inflatable penile implant procedures carried out by a single high-volume surgeon. Eight patients underwent subcutaneous reservoir placement (SRP) and are the subject of this review. RESULTS Eight of our last 1000 patients underwent SRP. SRP was only employed in patients with a thick subcutaneous abdominal fat layer, which would be capable of concealing the reservoir. Seven patients recovered uneventfully, and none reported a palpable or visible reservoir. One patient, who had 5 prior penile implant procedures, developed peri-prosthetic infection, and required complete device removal. Reservoir removal in this obese patient was facilitated by the device's subcutaneous location. CONCLUSION SRP is a viable option for carefully selected obese patients. We suggest that this approach only be utilized in those with high body mass index and a thick subcutaneous abdominal fat layer. In thinner patients, the reservoir will be visible and/or palpable; we do not recommend subcutaneous placement under those circumstances.
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