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Avoiding deep pelvic complications using a 'Five-Step' technique for high submuscular placement of inflatable penile prosthesis reservoirs.
Baumgarten, Adam S; Kavoussi, Mehraban; VanDyke, Maia E; Ortiz, Nicolas M; Khouri, Roger K; Ward, Ellen E; Hudak, Steven J; Morey, Allen F.
Afiliación
  • Baumgarten AS; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Kavoussi M; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • VanDyke ME; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Ortiz NM; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Khouri RK; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Ward EE; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Hudak SJ; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Morey AF; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
BJU Int ; 126(4): 457-463, 2020 10.
Article en En | MEDLINE | ID: mdl-32400957
ABSTRACT

OBJECTIVES:

To compare our extended experience with high submuscular (HSM) reservoir placement to traditional space of Retzius (SOR) placement and to present our current, refined 'Five-Step' technique (FST) for HSM placement. PATIENTS AND

METHODS:

Data were retrospectively collected on patients undergoing inflatable penile prosthesis (IPP) placement between January 2009 and June 2019. Re-operative cases were excluded. Reservoir-related complications and subsequent revisions were compared between SOR (2009-2012) and HSM reservoir groups (2012-2019). HSM patients were subdivided into two cohorts 'Initial Technique' (2012-2014) and FST (2014-2019). The refined FST protocol was developed in 2014 to optimise outcomes and includes the following

steps:

(i) Position and Access; (ii) Develop Lower HSM Pocket; (iii) Develop Upper HSM Pocket; (iv) Reservoir Delivery (fill and fine-tune); (v) Confirm and Connect.

RESULTS:

Between January 2009 and June 2019, 733 total IPP procedures (586 HSM, 147 SOR) were performed by a single surgeon at our institution, 561 of which were virgin cases (430 HSM, 131 SOR) and included in this analysis. Overall, surgical revision was required in 10/430 (2.3%) HSM cases (one delayed bowel obstruction, nine herniations) and six of 131 (4.6%) SOR cases (one bladder erosion, two vascular injuries, and three herniations, P = 0.22). When comparing the FST to the Initial Technique, we noted a significant decrease in complications requiring surgical revision (P = 0.01). Among 133 cases performed with the Initial Technique, seven (5.3%) required surgical revision (one bowel obstruction after placement into the peritoneal cavity, six herniations). Among 297 FST cases, three (1.0%) required revision, all due to herniation.

CONCLUSION:

HSM placement of IPP reservoirs is a safe alternative to traditional SOR placement. Major deep pelvic reservoir complications were minimised using our current refined FST.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Prótesis de Pene / Implantación de Pene / Disfunción Eréctil Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Humans / Male / Middle aged Idioma: En Revista: BJU Int Asunto de la revista: UROLOGIA Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Prótesis de Pene / Implantación de Pene / Disfunción Eréctil Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Humans / Male / Middle aged Idioma: En Revista: BJU Int Asunto de la revista: UROLOGIA Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos