title: High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes.
abstract: OBJECTIVE
  To present our updated experience and patient-reported outcomes of high submuscular (HSM) placement of urologic prosthetic balloons and reservoirs (UPBRs).
  
  
  METHODS
  A retrospective review was performed of patients who underwent inflatable penile prosthesis and/or artificial urinary sphincter placement between 2011 and 2013. UPBRs were placed in an HSM location between the transversalis fascia and the rectus abdominis muscle by blunt dissection through the external inguinal ring via a trans-scrotal approach. Patient demographics, perioperative outcomes, and patient-reported outcomes were reviewed.
  
  
  RESULTS
  During the study period, 146 patients received 158 HSM implants: inflatable penile prosthesis reservoirs (n = 93) or artificial urinary sphincter balloons (n = 65). Patients completed a standardized survey at a mean of 3.2 months (range, 1.1-23.4 months) after surgery and were last followed up at a mean of 5.5 months (range, 1.1-28.7 months). Overall, 94% (n = 149) of UPBRs caused no bother, and patients were satisfied with 96% (n = 151) of implants. Patients were unable to palpate 80% (n = 126) of UPBRs and minimally palpate 16% (n = 26). The primary surgeon was unable to palpate 72% (n = 115) of UPBRs and minimally palpate 20% (n = 31). Type of UPBR, body mass index, reservoir volume, and reservoir manufacturer were not associated with patient or surgeon palpability. Of the 158 UPBRs placed, only 2 (1.3%) were revised due to bothersome patient palpability. No bowel, bladder, ureteral, or vascular injuries occurred.
  
  
  CONCLUSIONS
  HSM placement of UPBR is safe and feasible, well tolerated, and avoids deep retropubic dissection. Patient-reported outcomes support low palpability, low bother, and high patient satisfaction.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: allen.morey@utsouthwestern.edu.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: J Francis
authors.initials: JF
authors.lastname: Scott
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D007172:Erectile Dysfunction / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D015917:Penile Prosthesis; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016741:Urinary Sphincter, Artificial