Author Reply

Abstract

We would like to thank the reviewers for their thoughtful comments. 1 Wilson S.K. Subcutaneous placement of inflatable penile prosthesis reservoirs [Editorial Comment]. Urology. 2015; (in press) PubMed Google Scholar On April 13, 2015, Coloplast Corp. received U.S. FDA approval for ectopic reservoir placement. This approval was based on FDA review of 9 published references. 2 Smaldone MC Cannon GM Benoit RM Subcutaneous reservoir placement during penile prosthesis implantation. Can J Urol. 2006; 13: 3351-3352 PubMed Google Scholar , 3 Perito PE Ectopic reservoir placement–no longer in the space of Retzius. J Sex Med. 2011; 8: 2395-2398 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 4 Perito PE Wilson SK Traditional (retroperitoneal) and abdominal wall (ectopic) reservoir placement. J Sex Med. 2011; 8: 656-659 Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar , 5 Hartman RJ Jr., Helfand BT McVary KM Outcomes of lateral retroperitoneal reservoir placement of three-piece penile prosthesis in patients following radical prostatectomy. Int J Impot Res. 2010; 22: 279-283 Crossref PubMed Scopus (26) Google Scholar , 6 Chung PH Morey AF Tausch TJ et al. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology. 2014; 84: 1540-1545 Google Scholar , 7 Stember DS Garber BB Perito PE Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. J Sex Med. 2014; 11: 605-612 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar , 8 Karpman E Brant WO Kansas B et al. Reservoir alternate surgical implantation technique: preliminary outcomes of initial PROPPER study patients consecutively implanted with low profile or spherical reservoir in submuscular location or traditional prevesical space. J Urol. 2014; https://doi.org/10.1016/j.juro.2014.007.082 Crossref PubMed Google Scholar , 9 Karpman E et al. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med. 2013; 10: 2115-2120 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar , 10 Tausch TJ et al. High submuscular versus space of Retzius placement of inflatable penile prosthesis reservoirs: results of a surgeon survey. Can J Urol. 2014; 21: 7465-7469 PubMed Google Scholar In our series, we have expanded the published literature on ectopic reservoirs, specifically involving subcutaneous reservoir placement (SRP). We used this technique on <1% of patients, specifically those with a thick subcutaneous fat layer, which would be capable of concealing the reservoir. However, we do not yet feel that ectopic placement should be considered a paradigm shift. There is a large amount of literature reporting on traditional space of Retzius (SOR) placement, and a much smaller amount concerning ectopic placement. Ectopic placement does not conceal the reservoir as well as SOR placement in thin individuals. We believe that more patients, more authors, and longer follow-up are required before we come to any final conclusions about these issues. We continue to prefer SOR reservoir placement in uncomplicated cases, and have published recommendations on how to avoid visceral injury. 11 Garber BB Morris A Intravesical penile implant reservoir: case report, literature review, and strategies for prevention. Int J Imp Res. 2012; 25: 41-44 Crossref PubMed Scopus (17) Google Scholar However, for those patients with anatomic issues (eg, hernia repair with mesh, prior pelvic surgery, morbid obesity, etc.) we freely use ectopic placement. Ectopic sites we have safely used include the space immediately subjacent to: the rectus muscle, the anterior rectus fascia, the external oblique muscle, the external oblique fascia, and Scarpa's fascia. Rather than considering ectopic placement as a paradigm shift, we prefer to consider these techniques as additional reservoir placement options that implanting urologists now have at their disposal.