Abstract Introduction Inflatable penile prosthesis (IPP) implantation is an established treatment for erectile dysfunction. Traditional reservoir placement in the space of Retzius can risk visceral and vascular injury. To avoid these complications, several ectopic and submuscular alternatives have been described. Objective To describe the Hamdan Extrainguinal Sub-Oblique (HESO) technique, a novel reservoir placement method that offers complete visualization and avoids the Retzius space, and to present peri- and postoperative outcomes in 192 patients. Methods We retrospectively analyzed 192 consecutive men undergoing primary IPP implantation with the HESO technique between March 2025 to June 2025 at a high-volume prosthetic center. All procedures were performed through a single penoscrotal incision. Demographic, clinical, and perioperative variables were recorded, and all patients were followed for reservoir-related or general prosthesis complications. Results A total of 192 men (mean age 55.9 ± 10 years; mean BMI 29.3 ± 4.8 kg/m2) underwent IPP implantation using the HESO technique. Common comorbidities included diabetes (62.5%) and hypertension (39.1%). The technique was successfully performed in all patients via a single penoscrotal incision. There were no intraoperative injuries to the bladder, bowel, or major vessels. At 3-6 months follow-up, no reservoir-specific complications (e.g., herniation, migration, or pain) were observed. The overall device-related complication rate was 1.0%, consisting of one case of infection (0.5%) and one case of malfunction (0.5%) Conclusions HESO technique is a reproducible method for IPP reservoir placement that offers direct visualization while avoiding both the space of Retzius and the inguinal canal. In this 192-patient retrospective series, the technique was associated with 0% rates of intraoperative injury and reservoir-specific complications, such as herniation. HESO appears to be a safe and effective alternative to traditional reservoir placement, though further prospective, multi-center studies are needed to validate these promising outcomes Disclosure No
Hamdan et al. (Mon,) studied this question.