IPP reservoir fixation techniques: THALIA and low transfascial

Abstract

Objective: Inflatable penile prosthesis reservoir herniation or migration may occur with space of Retzius or submuscular placement. The dangers of high submuscular placement include bowel or bladder perforation (from blind instrument passage) and or bowel herniation (from unintentional peritoneal placement and stretching of small opening with reservoir filling). Even under direct vision submuscular placement, reservoirs can ultimately reside into the scrotum, retroperitoneum, and lateral abdominal wall. The Tubing, Hitch And Lasso, Intussusception Anchor (THALIA) and the low Transfascial Fixation (TFF) techniques were recently developed to prevent reservoir migration with placement either submuscularly or in the space of Retzius, but video of these techniques has not been previously published. The aim of this study is to visually demonstrate the proper surgical technique of THALIA and TFF during IPP reservoir placement. Patients and Surgical Procedure: Two IPP surgical candidates at high risk of complications should reservoir migration occur were identified. Video of THALIA and TFF techniques performed during IPP surgery was recorded using an in-light overhead camera and a GoPro aseptically positioned on the lead surgeon. The THALIA technique adheres the reservoir tubing to the pubic bone by use of a 2–0 Ethibond suture and an extra tubing collar. The TFF technique fixates the reservoir tubing by perforating the external inguinal ring and running the tubing through the ring. Results: Successful demonstration of THALIA and TFF techniques during IPP placement without complications. Conclusions: THALIA and TFF techniques are feasible options to aid prevention of penile implant reservoir herniation.

Keywords

• Penile Prosthesis
• Reservoir Complications
• Reservoir Herniation
• Surgical Technique