The Tubing, Hitch and Lasso, Intussusception Anchor (THALIA) Technique: A Novel Approach to Fixate the Penile Implant Reservoir.

BACKGROUND: Penile implant reservoir herniation or migration after inflatable penile prosthesis (IPP) placement may occur with standard or submuscular placement. Additionally, fixating the tubing in patients with retained reservoirs may be helpful for future prosthetic surgeons. AIM: We describe a novel technique to fixate IPP reservoirs in the preferred position. METHODS: We present our preferred technique to fixate IPP reservoirs to prevent migration or herniation. OUTCOMES: We evaluated our success in preventing reservoir herniation or migration. RESULTS: 35 cases successfully underwent our new technique. 30 cases involved reservoirs that were thought to be at a high risk for migration. 5 cases were performed in non-infected retained reservoir scenarios where a reasonable attempt at removal either failed or was considered high risk. No immediate reservoir or infectious complications occurred. Mean follow-up was 5 months. The technique extended the case time by 5-10 minutes. CONCLUSION: Our novel technique is feasible, and although further follow-up and power are needed, fixating the pump tubing may reduce reservoir complications. Yang D, Heslop D, Houlihan M, et al. The Tubing, Hitch and Lasso, Intussusception Anchor (THALIA) Technique: A Novel Approach to Fixate the Penile Implant Reservoir. J Sex Med 2021;18:224-229.

Surgical patient selection and counseling.

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm.