High Submuscular Placement of Urologic Prosthetic Balloons and Reservoirs via Transscrotal Approach

Allen F. Morey, Christopher A. Cefalu, Steven J. Hudak

Research output: Contribution to journalArticlepeer-review

90 Scopus citations


Introduction. Traditional placement of inflatable penile prosthesis (IPP) reservoirs and/or artificial urinary sphincter (AUS) balloons into the space of Retzius may be challenging following major pelvic surgery. Aim. The aim of this study is to report our 1-year experience using a novel technique for high balloon/reservoir placement beneath the rectus abdominus muscle, thus completely obviating deep pelvic dissection during prosthetic urologic surgery. Methods. A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and June 2012 was performed. All had AUS balloons and/or IPP reservoirs placed in a submuscular location by bluntly tunneling through the external inguinal ring into a potential space between the transversalis fascia and the rectus abdominus muscle using a long, angled, lung grasping clamp. Main Outcome Measures. Patient demographics, perioperative outcomes, and initial follow-up patient-reported outcomes were reviewed. Results. During the study period, 120 submuscular balloons/reservoirs were inserted in 107 consecutive patients who underwent placement of an IPP (61 patients), AUS (33 patients), or both (13 patients). Among our 48 most recent patients, 41 (85%) reported they were totally unable to feel their balloon/reservoir, and all but two patients reported no bother from the submuscular balloon/reservoir placement. Of the 120 total submuscular balloons and reservoirs, surgical time and outcomes of the prosthetic procedures appeared similar to those placed using traditional methods; two reservoirs required revision surgery for repositioning. Conclusions. High submuscular placement of genitourinary prosthetic balloons and reservoirs via a transscrotal approach is both safely and effective, while avoiding deep retropubic dissection.

Original languageEnglish (US)
Pages (from-to)603-610
Number of pages8
JournalJournal of Sexual Medicine
Issue number2
StatePublished - Feb 2013


  • Artificial urinary sphincter
  • Erectile dysfunction
  • Penile prosthesis
  • Urinary incontinence

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology


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