LAUSR

BACKGROUND High submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs is a promising new FDA approved alternative to traditional space of Retzius (SOR) reservoir placement. In 2011, we began placing all reservoirs in a HSM position at our tertiary center. In 2014, we proposed a refined, "Five-Step" HSM reservoir placement technique (FST) to prevent deep pelvic complications. OBJECTIVES To describe our HSM technique and report on our extended experience. MATERIAL Our refined FST was developed to optimize outcomes and includes the following steps: 1) Position and Access; 2) Develop Lower HSM Pocket; 3) Develop Upper HSM Pocket; 4) Reservoir Delivery (Fill and Fine-Tune); 5) Confirm and Connect. Data was retrospectively collected on patients undergoing reservoir placement by FST between January 2014- June 2019. A survey analyzing subjective outcomes and patient satisfaction was performed among 100 randomly selected patients. RESULTS We placed 297 consecutive HSM IPP reservoirs via FST during this time period. Three patients (1.0%) required surgical revision (all for herniation). No deep pelvic (vascular, bladder, bowel) complications were reported. Of the 100 patients that were randomly surveyed, 86% of patients reported no palpability of the reservoir, and 95% of patients reported satisfaction with the procedure and would recommend the procedure to a friend. CONCLUSION The FST for HSM reservoir placement is a simple and safe procedure with good outcomes and excellent patient satisfaction. This technique appears to effectively eliminate the risks of deep pelvic complications.