Baumgarten Adam S, Kavoussi Mehraban, 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.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Urology. 2020 Nov;145:298. doi: 10.1016/j.urology.2020.07.039. Epub 2020 Aug 4.
High submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs is a promising new FDA approved alternative to traditional space of Retzius reservoir placement. In 2011, we began placing all reservoirs in a HSM position at our tertiary center. In 2014, we proposed a refined, "Five-Step" HSM reservoir placement technique (FST) to prevent deep pelvic complications.
To describe our HSM technique and report on our extended experience.
Our refined FST was developed to optimize outcomes and includes the following steps: (1) Position and Access; (2) Develop Lower HSM Pocket; (3) Develop Upper HSM Pocket; (4) Reservoir Delivery (Fill and Fine-Tune); (5) Confirm and Connect. Data was retrospectively collected on patients undergoing reservoir placement by FST between January 2014 and June 2019. A survey analyzing subjective outcomes and patient satisfaction was performed among 100 randomly selected patients.
We placed 297 consecutive HSM IPP reservoirs via FST during this time period. Three patients (1.0%) required surgical revision (all for herniation). No deep pelvic (vascular, bladder, bowel) complications were reported. Of the 100 patients that were randomly surveyed, 86% of patients reported no palpability of the reservoir, and 95% of patients reported satisfaction with the procedure and would recommend the procedure to a friend.
The FST for HSM reservoir placement is a simple and safe procedure with good outcomes and excellent patient satisfaction. This technique appears to effectively eliminate the risks of deep pelvic complications.
可膨胀阴茎假体（IPP）储液囊的高位肌下（HSM）放置是一种新的、有前景的方法，已获美国食品药品监督管理局（FDA）批准，可替代传统的耻骨后间隙储液囊放置方法。2011年，我们在三级医疗中心开始将所有储液囊置于HSM位置。2014年，我们提出了一种改良的“五步”HSM储液囊放置技术（FST），以预防深部盆腔并发症。
描述我们的HSM技术并报告我们的长期经验。
我们改良的FST旨在优化手术效果，包括以下步骤：（1）定位与入路；（2）构建低位HSM腔隙；（3）构建高位HSM腔隙；（4）置入储液囊（填充与微调）；（5）确认与连接。回顾性收集了2014年1月至2019年6月期间采用FST进行储液囊放置的患者的数据。对100例随机选择的患者进行了一项分析主观结果和患者满意度的调查。
在此期间，我们通过FST连续放置了297个HSM IPP储液囊。3例患者（1.0%）需要手术翻修（均因疝形成）。未报告深部盆腔（血管、膀胱、肠道）并发症。在随机调查的100例患者中，86%的患者报告触不到储液囊，95%的患者报告对手术满意，并会向朋友推荐该手术。
HSM储液囊放置的FST是一种简单、安全的手术，效果良好，患者满意度高。该技术似乎能有效消除深部盆腔并发症的风险。
