Counter Incision for Safe Reservoir Placement in Penile Prosthesis Surgery

A. Al Homsi, K. Khalafalla, O. Almidani, R. Rowaiee, O. A. Raheem

Counter incision, Penile prosthesis, Reservior placement

This video presents two surgical cases demonstrating the use of a counter incision for safe and controlled reservoir placement during inflatable penile prosthesis (IPP) surgery. In the first case, following standard cylinder placement through a penoscrotal approach, a small transverse incision above the inguinal ligament was used to access the space of Retzius for reservoir placement under direct visualization. In the second case, due to altered inguinal anatomy, the same counter incision was utilized to develop a high submuscular pocket superficial to the transversalis fascia for ectopic reservoir placement. In both cases, direct dissection allowed clear identification of anatomical layers and safe reservoir deployment without injury to surrounding structures. Traditional blind reservoir insertion carries increased risk in patients with prior pelvic surgery or distorted anatomy. This video highlights a straightforward and reproducible technique that provides excellent anatomical exposure, particularly useful in revision settings or complex pelvic cases. By shifting away from blind dissection, the counter incision approach offers improved safety, precision, and confidence in reservoir placement for both primary and challenging IPP procedures.

None.

The authors have nothing to disclose

1. Ivan, S. et al. (2025) ‘Reservoir placement options: A state of the art review’, International Journal of Impotence Research [Preprint]. doi:10.1038/s41443-025-01082-x.

2. Grimberg, D. et al. (2020) ‘Counter incision is a safe and effective method for alternative reservoir placement during inflatable penile prosthesis surgery’, Translational Andrology and Urology, 9(6), pp. 2688–2696. doi:10.21037/tau-20-923.