Mykoniatis Ioannis, Osmonov Daniar, van Renterghem Koenraad
Department of Urology, Jessa Hospital, Hasselt, Belgium.
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany.
Sex Med. 2020 Sep;8(3):378-382. doi: 10.1016/j.esxm.2020.04.004. Epub 2020 May 17.
At the moment, there is an ongoing debate regarding the controversial issue of the ideal reservoir placement (RP) surgical technique during implantation of a 3-piece inflatable penile prosthesis, but a definitive winner has not yet emerged.
In this light, we herein describe our modified technique for RP into the space of Retzius through the external oblique muscle fascia and present its results.
In total, 253 inflatable penile prosthesis procedures (110 AMS 700 and 143 Coloplast Titan) via a single transverse penoscrotal incision were retrospectively reviewed. 2 Kocher-Langenbeck retractors were placed over the right side of the penoscrotal incision and were used to retract the incision superior to the pubic bone. Then, the external oblique muscle fascia was incised medially to the spermatic cord which was retracted laterally. Next, a "W", Vicryl 1, stay suture was placed to the incision, and under direct visualization, external oblique muscle fibers were dissected and fascia transversalis was perforated using a Metzenbaum scissor. A Foerster lung grasping clamp was then used to dissect further into the extraperitoneal space and create the reservoir space. The reservoir was placed into the created space and fascia incision was closed using the prepositioned stay suture. The procedure was then completed in a standard fashion.
The main outcome measures were intraoperative or postoperative complications of our modified RP technique.
All 253 patients were available for short-term follow-up (average 9.1 months, range 3-22 months). No intraoperative or postoperative complications were reported. Reservoir-related prolonged pain (1 month) was reported by 1 patient, resolving completely after treatment with non-steroidal analgesics.
We are, surely, not proposing that our modified RP technique should supplant all other methods; rather, it should be considered another useful option for RP in the implanter's armamentarium. Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inatable Penile Prosthesis Implantation. Sex Med 2020;8:378-382.
目前，关于三件式可膨胀阴茎假体植入过程中理想的贮液器放置（RP）手术技术这一有争议的问题正在进行辩论，但尚未有明确的定论。
有鉴于此，我们在此描述通过腹外斜肌筋膜将贮液器放置于Retzius间隙的改良技术，并展示其效果。
回顾性分析了253例通过单一横向阴茎阴囊切口进行的可膨胀阴茎假体手术（110例使用AMS 700，143例使用柯洛普拉斯泰坦）。将2个Kocher-Langenbeck牵开器置于阴茎阴囊切口右侧，用于将切口牵至耻骨上方。然后，在精索内侧切开腹外斜肌筋膜，将精索向外侧牵开。接下来，在切口处放置一根“W”形的薇乔1号缝线作为定位缝线，在直视下，解剖腹外斜肌纤维，并用梅氏剪刀穿透腹横筋膜。然后使用福斯特肺叶钳进一步向腹膜外间隙进行解剖，形成贮液器空间。将贮液器放入形成的空间，使用预先放置的定位缝线关闭筋膜切口。然后以标准方式完成手术。
主要观察指标为我们改良的RP技术的术中或术后并发症。
所有253例患者均获得短期随访（平均9.1个月，范围3 - 22个月）。未报告术中或术后并发症。1例患者报告了与贮液器相关的持续性疼痛（1个月），使用非甾体类镇痛药治疗后完全缓解。
当然，我们并不是提议我们改良的RP技术应取代所有其他方法；相反，它应被视为植入者手术方法中的另一种有用选择。Mykoniatis I, Osmonov D, van Renterghem K. 可膨胀阴茎假体植入术中贮液器放置的改良手术技术。性医学2020；8：378 - 382。
