{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:02:10Z","timestamp":1767981730333,"version":"3.49.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,12,27]],"date-time":"2021-12-27T00:00:00Z","timestamp":1640563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2021,12,27]],"date-time":"2021-12-27T00:00:00Z","timestamp":1640563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Submuscular reservoir placement has fulfilled a critical need for patients desiring multicomponent penile implants following pelvic surgery and radiation therapy. Passage of the reservoir through the inguinal canal into the submuscular space is often challenging and carries the risk of the reservoir being placed unknowingly outside of the targeted space.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the safety and accuracy of a direct vision, transfascial (DVT) approach to submuscular reservoir placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed outcomes for consecutive patients undergoing DVT submuscular reservoir placement abstracted from a large IRB-approved database at our institution. Postimplant cross-sectional imaging performed on many of these patients was used to ascertain the final location of the reservoir.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Outcome measures included the perioperative and intermediate-term safety and complications of the procedure. Postimplant imaging ascertained the accuracy in providing patients with a submuscular reservoir.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 107 DVT submuscular reservoirs placed in 100 consecutive patients. No intraoperative complications occurred, there were no postoperative rectus hematomas, and there were 4 (3.7%) postoperative infections. With a mean follow up of 17.5 +\/- 20.5 months there was one reservoir herniation, one patient had autoinflation, and one patient required repositioning of a high riding pump. There were 4 mechanical malfunctions requiring revision at a median of 74 months (range: 69\u2013108 months.) following implant placement. Of the 43 patients who underwent imaging: 34 (79%) reservoirs were accurately positioned, 5 (12%) were in the lateral abdominal wall, 1(2%) was in the retroperitoneum, and 3 (7%) were intraperitoneal. Intraperitoneal reservoirs occurred exclusively in postcystectomy patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>The DVT approach is technically safe, although a slightly higher than expected infection risk was noted. It provides accurate reservoir placement for the majority of imaged patients. Postcystectomy patients have a risk of insidious intraperitoneal reservoir placement. Preoperative counseling should mention this and postimplant imaging may be considered for some of these patients. Imaging may also helpful prior to future revision surgery in order to identify and remove insidious intraperitoneal reservoirs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths and Limitations<\/jats:title><jats:p>We investigated 100 patients, almost half underwent cross sectional imaging. Weaknesses include the retrospective nature of this single-institutional study, which may not have similar outcomes at other centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DVT submuscular reservoir placement is safe following pelvic surgery and radiation therapy. Despite careful and deliberate surgical technique imaging found that approximately 20% of reservoirs are not in their expected location. Intraperitoneal reservoirs are of concern, particularly in postcystectomy patients.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jsxm.2021.11.012","type":"journal-article","created":{"date-parts":[[2021,12,27]],"date-time":"2021-12-27T12:45:06Z","timestamp":1640609106000},"page":"394-400","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":8,"title":["Direct Vision, Transfascial (DVT) Approach to Submuscular Reservoir Placement in Patients Undergoing Multicomponent Penile Implant Surgery Following Prior Pelvic Surgery or Radiation Therapy"],"prefix":"10.1093","volume":"19","author":[{"given":"Bruce R.","family":"Kava","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Levine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Masterson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjith","family":"Ramasamy","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Miami, Miller School of Medicine , Miami, FL , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,12,27]]},"reference":[{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/S0022-5347(05)64477-1","article-title":"The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement","volume":"168","author":"Wilson","year":"2002","journal-title":"J Urol"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1743-6109.2011.02202.x","article-title":"Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement","volume":"8","author":"Perito","year":"2011","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/jsm.12000","article-title":"High sub muscular placement of urologic prosthetic balloons and reservoirs via transcrotal approach","volume":"10","author":"Morey","year":"2013","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/jsm.12408","article-title":"Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius","volume":"11","author":"Stember","year":"2014","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.jsxm.2018.01.014","article-title":"3-Piece inflatable penile prosthesis placement following radical cystoprostatectomy and urinary diversion: technique and outcomes","volume":"15","author":"Loh-Doyle","year":"2018","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/ijir.2010.16","article-title":"Outcomes of lateral retroperitoneal reservoir placement of three-piece penile prosthesis in patients following radical prostatectomy","volume":"22","author":"Hartman","year":"2010","journal-title":"Int J Impot Res"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1111\/jsm.12203","article-title":"Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the sexual medicine society of North America","volume":"10","author":"Karpman","year":"2013","journal-title":"J Sex Med"},{"key":"2023041407173439000_","first-page":"7465","article-title":"High submuscular versus space of Retzius placement of inflatable penile prosthesis reservoirs: results of a surgeon survey","volume":"21","author":"Tausch","year":"2014","journal-title":"Can J Urol"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/j.jsxm.2016.06.012","article-title":"Ectopic penile prosthesis reservoir placement: an anatomic cadaver model of the high submuscular technique","volume":"13","author":"Ziegelman","year":"2016","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/ijir.2017.26","article-title":"A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement","volume":"29","author":"Gross","year":"2017","journal-title":"Int J Impot Res"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jsxm.2018.12.015","article-title":"Trans-fascial placement of a high, submuscular reservoir in patients following radical cystectomy; safety, efficacy, and predictability of final reservoir location verified with abdominal imaging","volume":"16","author":"Kava","year":"2019","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.juro.2015.08.091","article-title":"The malleable implant salvage technique: infection outcomes after Mulcahy salvage procedure and replacement of infected inflatable penile prosthesis with malleable prosthesis","volume":"195","author":"Gross","year":"2016","journal-title":"J Urol"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/01.ju.0000146717.62215.6f","article-title":"Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study","volume":"173","author":"Henry","year":"2005","journal-title":"J Urol"},{"issue":"suppl 7","key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/jsm.13011","article-title":"The evolution of the inflatable penile prosthesis reservoir and surgical placement","volume":"12","author":"Hakky","year":"2015","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1038\/s41443-020-0269-x","article-title":"Should occasional implanters learn ectopic placement of IPP reservoirs?","volume":"32","author":"Wilson","year":"2020","journal-title":"Int J Impot Res"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/j.urology.2014.08.029","article-title":"High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes","volume":"84","author":"Chung","year":"2014","journal-title":"Urology"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.juro.2018.10.013","article-title":"Emerging complications following alternative reservoir placement during inflatable penile prosthesis placement: a 5-year multi-institutional experience","volume":"201","author":"Hernandez","year":"2019","journal-title":"J Urol"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/jsm.12361","article-title":"Pertinent anatomical measurements of the retropubic space: A guide for inflatable penile prosthesis reservoirs shows that the external iliac vein is much closer than thought","volume":"11","author":"Henry","year":"2014","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1111\/jsm.12239","article-title":"Erosion of inflatable penile prosthesis reservoir into neobladder","volume":"9","author":"Tran","year":"2013","journal-title":"J Sex Med"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/ijir.2017.26","article-title":"A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement","volume":"29","author":"Gross","year":"2017","journal-title":"Int J Impot Res"},{"key":"2023041407173439000_","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1111\/j.1743-6109.2011.02222.x","article-title":"Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single surgeon series","volume":"8","author":"Kava","year":"2011","journal-title":"J Sex Med"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521007888?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521007888?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/19\/2\/394\/49878349\/jsm_19_2_394.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/19\/2\/394\/49878349\/jsm_19_2_394.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T21:58:29Z","timestamp":1699999109000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/19\/2\/394\/6961245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,27]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,12,27]]},"published-print":{"date-parts":[[2022,2,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.11.012","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2022,2]]},"published":{"date-parts":[[2021,12,27]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Direct Vision, Transfascial (DVT) Approach to Submuscular Reservoir Placement in Patients Undergoing Multicomponent Penile Implant Surgery Following Prior Pelvic Surgery or Radiation Therapy","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.11.012","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}