Hamdan Extrainguinal Sub-Oblique (HESO) Technique for Reservoir Placement in Inflatable Penile Prosthesis Surgery

M. Hamdan, M. Ghassab Deameh, A. Sadeq

Inflatable penile prosthesis, reservoir placement, ectopic placement, erectile dysfunction, surgical technique, HESO

Inflatable penile prosthesis (IPP) remains the most effective solution for refractory erectile dysfunction.¹ Traditionally, reservoirs are placed retropubically in the space of Retzius; however, this approach carries risks of visceral and vascular injury, particularly in patients with "hostile" pelvic anatomy from prior surgery or radiation.² Existing ectopic techniques have notable trade-offs: inguinal canal approaches risk nerve injury, cord compression, and high misplacement rates,³ while deep sub-rectus methods may lead to unintended intraperitoneal contact.⁴ The Hamdan Extrainguinal Sub-Oblique (HESO) technique provides a reliable alternative by creating a submuscular pocket that avoids these risk zones entirely. Performed through a single transverse scrotal incision, a subcutaneous tunnel is created superior to the inguinal canal. The external oblique muscle (EOM) aponeurosis is incised, and a space is bluntly dissected between the EOM and the underlying internal oblique muscle. This allows for stable reservoir placement approximately 2 cm medial to the anterior superior iliac spine under direct visualization. HESO technique demonstrated an average operative time of 40±15 minutes. No reservoir herniation or migration was observed. HESO may represent a useful advancement in IPP surgery, providing a safe and broadly applicable approach that could support postoperative recovery and surgical outcomes, including in complex pelvic cases.

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