In our never ending quest to make penile implant reservoir placement safe for all implanters, we have identified a very small subset of patients (smokers and patients with low BMI’s) who may be at risk for adverse events.  The incidence of complications was so low that they almost could be considered case reports.  But, careful identification of the space posterior to transversalis fascia in these patients should preclude any bowel, bladder, vascular injury or hernia.