Baumgarten Adam S, Kavoussi Mehraban, VanDyke Maia E, Ortiz Nicolas M, Khouri Roger K, Ward Ellen E, Hudak Steven J, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
BJU Int. 2020 Oct;126(4):457-463. doi: 10.1111/bju.15106. Epub 2020 Jul 2.
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.
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.
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.
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.
比较我们在高位肌下（HSM）放置贮尿囊的丰富经验与传统的耻骨后间隙（SOR）放置，并介绍我们目前用于HSM放置的改良“五步”技术（FST）。
回顾性收集2009年1月至2019年6月期间接受可膨胀阴茎假体（IPP）植入手术的患者数据。排除再次手术病例。比较SOR组（2009 - 2012年）和HSM贮尿囊组（2012 - 2019年）与贮尿囊相关的并发症及随后的翻修情况。HSM组患者分为两个队列：“初始技术”组（2012 - 2014年）和FST组（2014 - 2019年）。改良的FST方案于2014年制定以优化手术效果，包括以下步骤：（i）定位与入路；（ii）创建低位HSM腔隙；（iii）创建高位HSM腔隙；（iv）放置贮尿囊（填充并微调）；（v）确认与连接。
2009年1月至2019年6月期间，我们机构的一名外科医生共进行了733例IPP手术（586例HSM，147例SOR），其中561例为初次手术病例（430例HSM，131例SOR）并纳入本分析。总体而言，430例HSM病例中有10例（2.3%）需要手术翻修（1例迟发性肠梗阻，9例疝），131例SOR病例中有6例（4.6%）需要手术翻修（1例膀胱侵蚀，2例血管损伤，3例疝，P = 0.22）。将FST与初始技术进行比较时，我们注意到需要手术翻修的并发症显著减少（P = 0.01）。在采用初始技术进行的133例手术中，7例（5.3%）需要手术翻修（1例置入腹腔后肠梗阻，6例疝）。在297例FST手术病例中，3例（1.0%）需要翻修，均为疝所致。
IPP贮尿囊的HSM放置是传统SOR放置的一种安全替代方法。使用我们目前改良的FST可将主要的盆腔深部贮尿囊并发症降至最低。
