title: High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach.
abstract: BACKGROUND
  Traditional placement of inflatable penile prosthesis (IPP) reservoirs and/or artificial urinary sphincter (AUS) balloons into the space of Retzius may be challenging following major pelvic surgery.
  
  
  OBJECTIVE
  The aim of this study is to report our 1-year experience using a novel technique for high balloon/reservoir placement beneath the rectus abdominus muscle, thus completely obviating deep pelvic dissection during prosthetic urologic surgery.
  
  
  METHODS
  A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and June 2012 was performed. All had AUS balloons and/or IPP reservoirs placed in a submuscular location by bluntly tunneling through the external inguinal ring into a potential space between the transversalis fascia and the rectus abdominus muscle using a long, angled, lung grasping clamp.
  
  
  METHODS
  Patient demographics, perioperative outcomes, and initial follow-up patient-reported outcomes were reviewed.
  
  
  RESULTS
  During the study period, 120 submuscular balloons/reservoirs were inserted in 107 consecutive patients who underwent placement of an IPP (61 patients), AUS (33 patients), or both (13 patients). Among our 48 most recent patients, 41 (85%) reported they were totally unable to feel their balloon/reservoir, and all but two patients reported no bother from the submuscular balloon/reservoir placement. Of the 120 total submuscular balloons and reservoirs, surgical time and outcomes of the prosthetic procedures appeared similar to those placed using traditional methods; two reservoirs required revision surgery for repositioning.
  
  
  CONCLUSIONS
  High submuscular placement of genitourinary prosthetic balloons and reservoirs via a transscrotal approach is both safely and effective, while avoiding deep retropubic dissection.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA. Allen.morey@utsouthwestern.edu
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Cefalu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hudak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011468:Prostatectomy; D011474:Prosthesis Design; D012086:Reoperation; D012611:Scrotum / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery; D016741:Urinary Sphincter, Artificial