title: High submuscular versus space of Retzius placement of inflatable penile prosthesis reservoirs: results of a surgeon survey.
abstract: BACKGROUND
  High submuscular (HSM) inflatable penile prosthesis (IPP) reservoir insertion is a new technique that involves placing the reservoir high beneath the muscles of the abdominal wall. We queried a variety of surgeons to assess their impressions of how HSM reservoir placement compares with traditional space of Retzius (SOR) placement.
  
  
  METHODS
  A nationwide group of urologists trained in HSM reservoir placement was surveyed to assess preferences and concerns compared to SOR placement. Using a Likert scale survey, we compared HSM to traditional SOR placement with regard to ease of implementation, surgical preference, and patient safety. Results were analyzed according to numbers of implants performed by the surgeons.
  
  
  RESULTS
  A total of 25 urologists from eight states participated in this survey (12 residents and 13 attending surgeons). Overall, surgeons report that HSM placement is safer (p < 0.001). The participants believed it conveyed lower risk to visceral (p < 0.001) and vascular (p < 0.001) structures. Moreover it was easier to learn (p = 0.008) and to teach (p = 0.002). The majority (17/25, 68%) prefer HSM reservoir placement, while 4/25 (16%) are neutral, and 4/25 (16%) prefer SOR. Among high volume implanters (> 20 implants/year), 7/9 (78%) prefer the HSM technique and report that it is safer (p = 0.001) with lower risk of visceral (p = 0.010) and vascular (p < 0.001) injuries.
  
  
  CONCLUSIONS
  Urologists trained in HSM reservoir placement report that this technique is readily implemented, strongly preferred, and safer for patients.
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.forename: Paul
authors.initials: P
authors.lastname: Knoll
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.forename: J Francis
authors.initials: JF
authors.lastname: Scott
authors.forename: James R
authors.initials: JR
authors.lastname: Flemons
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D019935:Penile Implantation / Q000009:adverse effects / Q000379:methods*; D015917:Penile Prosthesis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014572:Urology / Q000706:statistics & numerical data*