Prolonged closed suction drains lowered hematoma rates and facilitated early pump operation after inflatable penile prosthesis implantation
Meng, Y1; Song, DG1; Brown, S2; Vetter, JM1; Bullock, AD1
1: Division of Urology, Washington University School of Medicine, United States; 2: School of Medicine, Washington University School of Medicine, United States
Objectives: Closed suction drains (CSD) for inflatable penile prosthesis (IPP) implantation is hypothesized to increase risk of infection from retrograde microbial migration, therefore it is customarily removed within 24 hours of placement. However, lack of drainage leads to scrotal hematoma and edema, creating a nidus for infection in addition to causing patient discomfort and delaying pump operation. We compared brief (<24 hours) vs. prolonged CSD after virgin IPP implantation.
Methods: A retrospective review of a single institution experience from 2010 to 2017 was performed. Consecutive patients without previous penile implantation were included. IPP revisions and malleable prosthesis implantations were excluded. Patients in the brief CSD group had drains removed within 24 hours of surgery prior to discharge. Patients in the prolonged CSD group were discharged with their drains. Baseline demographics, medical and surgical comorbidities, and duration of CSD were compared between the two groups. Infectious complications were assessed by chart review. Scrotal hematoma and ability to operate pump by patient were assessed at 3-4 weeks postop.
Results: Prolonged CSD group had an average drainage duration of 4.7 days (SD 2.4). There were no significant difference in age, BMI, race, medical comorbidities and surgical approach (98.3% vs 99.1% infrapubic) between brief and prolonged CSD patients. The prolonged CSD group had slightly higher operative time (82.6 vs. 74.7 min, p=0.05). At a median followup of 50 days, there was no significant difference in infection rates between the two groups (0.9% vs. 1.7%, p=1). Patients in the prolonged drain group were significantly less likely to have hematomas or swelling/discomfort preventing pump operation compared to the brief CSD group (14.4% vs. 26%, p=0.02). On multivariate analysis, prolonged CSD patients were 3 times more likely to be using their devices at 3-4 weeks postop (95% CI 1.54-5.63, p=0.001).
Conclusion: Prolonged CSDs after virgin IPP implantation lowered scrotal hematoma rates and facilitated early device usage without increasing risk of prosthesis infection.
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