Zisman Ariel, Razdan Shirin, Siegal Alexandra, Sljivich Michaela, Bieber Christine, Ho Patrick, Valenzuela Robert
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ther Adv Urol. 2022 Dec 6;14:17562872221139109. doi: 10.1177/17562872221139109. eCollection 2022 Jan-Dec.
One of the most challenging aspects of inflatable penile prosthesis (IPP) surgery is reservoir placement. The traditional space of Retzius (SOR) is not suitable for all patients. For example, radical cystectomy or prostatectomy may alter the anatomical SOR. Hence, traditional placement of the reservoir in this space increases the risk of bowel or vascular injury. Also, patients with bilateral inguinal hernias repaired with mesh, or those with previous reservoirs that have been retained, are not eligible for a Retzius reservoir. Our study reports on the use of midline sub-rectus muscle placement of a penile prosthesis reservoir in these patients as an alternative to high submuscular placement commonly used.
A retrospective chart review of male patients who underwent IPP surgery between June 2017 and 2021 was conducted. Patients were divided into two groups based on the location of the reservoir: SOR Midline Submuscular Reservoir (MSMR). Complication rates were compared, including herniated reservoirs, infections, bowel injuries, and vascular injuries.
Our cohort included 461 patients who underwent IPP surgery between June 2017 and 2021 in one tertiary center. SOR was used in 89% of patients and MSMR in 11% of patients ( = 413 and 48, respectively). Median follow-up for all patients was 28 months. The mean age was 67 ± 8 years. There was no statistically significant difference between the two groups regarding age or comorbidities (BMI, diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease). The complication rate was low in both the SOR and MSMR groups, with device malfunction being the most common (2% 4%, respectively; = 0.32). The infection rate was 0.5% in the SOR group with no infections in the MSMR group (NS). There was only one case of herniation requiring surgical revision in the SOR group and no cases of bowel or vascular injury.
Placement of a penile prosthesis reservoir within a midline rectus submuscular space is a safe and effective technique when the SOR is compromised by previous surgery or bilateral inguinal canals are not accessible.
可膨胀阴茎假体（IPP）手术最具挑战性的方面之一是储液囊的放置。传统的耻骨后间隙（SOR）并不适用于所有患者。例如，根治性膀胱切除术或前列腺切除术可能会改变耻骨后间隙的解剖结构。因此，在该间隙传统放置储液囊会增加肠道或血管损伤的风险。此外，接受网片修补双侧腹股沟疝的患者，或曾保留过储液囊的患者，均不适合在耻骨后间隙放置储液囊。我们的研究报告了在这些患者中使用阴茎假体储液囊中线腹直肌下放置法，作为常用的高位肌下放置法的替代方法。
对2017年6月至2021年期间接受IPP手术的男性患者进行回顾性病历审查。根据储液囊的位置将患者分为两组：耻骨后间隙组和中线腹直肌下储液囊（MSMR）组。比较两组的并发症发生率，包括储液囊疝出、感染、肠道损伤和血管损伤。
我们的队列包括2017年6月至2021年期间在一家三级中心接受IPP手术的461例患者。89%的患者使用耻骨后间隙法，11%的患者使用中线腹直肌下储液囊法（分别为413例和48例）。所有患者的中位随访时间为28个月。平均年龄为67±8岁。两组在年龄或合并症（BMI、糖尿病、高血压、高脂血症和冠状动脉疾病）方面无统计学显著差异。耻骨后间隙组和中线腹直肌下储液囊组的并发症发生率均较低，器械故障最为常见（分别为2%和4%；P = 0.32）。耻骨后间隙组的感染率为0.5%，中线腹直肌下储液囊组无感染（无显著性差异）。耻骨后间隙组仅1例疝出需要手术修复，无肠道或血管损伤病例。
当耻骨后间隙因既往手术受损或双侧腹股沟管无法使用时，在中线腹直肌下间隙放置阴茎假体储液囊是一种安全有效的技术。
