Outcomes of the Hamdan Extrainguinal Sub-Oblique (HESO) technique for reservoir placement in inflatable penile...

Inflatable penile prosthesis (IPP) implantation is the standard treatment for refractory erectile dysfunction, but traditional reservoir placement in the space of Retzius risks injury. Ectopic and submuscular alternatives were developed to mitigate these potential complications. We evaluated the safety, feasibility, and outcomes of the Hamdan Extrainguinal Sub-Oblique technique, which uses direct visualization to avoid the space of Retzius. In this retrospective single-center study, we analyzed 186 consecutive patients who underwent primary IPP implantation using the Hamdan Extrainguinal Sub-Oblique technique between February 2025 and June 2025. All reservoirs were placed via a single penoscrotal incision into the extrainguinal sub-oblique space. Demographic data, comorbidities (including glycated hemoglobin), and perioperative outcomes were recorded. The median age was 56 (IQR 11) years, and the median body mass index was 28.7(5.7) kg/m². Comorbidities included diabetes (62.9%), hypertension (39.8%), dyslipidemia (28.5%), and ischemic heart disease or heart failure (21.0%). Notably, there were no intraoperative or postoperative reservoir-related complications during a short-term follow-up period of nine months. General complications were rare, consisting of 1 infection (0.5%) and 1 mechanical failure (0.5%). The Hamdan Extrainguinal Sub-Oblique technique appears to be a safe and anatomically controlled option for reservoir placement in the short term. By providing direct visualization and avoiding the space of Retzius, it may reduce the risk of visceral or vascular injury in selected patients.