Hahnemann University Hospital, Philadelphia, PA, USA.
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Int J Impot Res. 2019 Nov;31(6):400-403. doi: 10.1038/s41443-018-0101-z. Epub 2019 Jan 3.
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.
多组件可充气阴茎假体（IPP）由成对的体内圆柱体、阴囊泵和腹部液体储液器组成。近年来，植入泌尿外科医生越来越多地采用异位（例如，非 Retzius 间隙）储液器插入技术。本研究旨在描述我们的 IPP 储液器的亚外斜肌（SEO）放置技术，并回顾我们使用该技术的初步经验。我们对 50 名通过阴囊切口接受科洛普 Titan IPP 植入术的患者进行了回顾性研究，采用了新开发的 SEO 储液器插入技术。所有手术均由一名高容量外科医生（BBG）完成，并进行了回顾性图表审查。患者在术后第 1 天、第 2 周、第 6 周进行随访，根据需要进行随访，此后定期进行随访。所有 50 名患者均接受了短期术后随访（平均 6.6 个月，范围 3-12 个月）。仅在没有先前腹股沟管手术且没有腹股沟疝证据的情况下使用 SEO 技术。SEO 技术易于实施，没有发生肠、膀胱、血管、神经或精索损伤。也没有储液器疝、腹腔内插入或储液器可见的情况。一名患者出现与储液器相关的持续性疼痛（4 周）；然而，在使用非甾体类镇痛药治疗后完全缓解。在虚弱的患者中，可以通过仔细的深部触诊检测到储液器。但是，迄今为止，没有患者需要或要求进行 IPP 修订或移除。短期随访结果表明，SEO 储液器插入术是一种易于进行且安全的异位储液器插入方法。SEO 方法避免了以前描述的储液器插入技术中罕见但严重的并发症。需要更长时间的随访和其他植入泌尿外科医生的试验，以确认或反驳这些初步的有希望的结果。
