Drain Volume Output Following IPP Implantation: An Analysis by Surgical Approach

Abstract

ABSTRACT Introduction Inflatable penile prosthesis (IPP) is the gold standard therapy in the surgical treatment of erectile dysfunction. Hematoma and seroma formation have been described following implantation. These fluid collections may be a significant source of patient pain and infection. Use of closed system drains after penile implantation has been described previously to manage these proactively, and are typically removed on post-op day one. Upon previous analysis, we demonstrated that an extended, three-day postoperative drain course resulted in a modest but significant decrease in postoperative use of pain medication without changing infection rates. Objective Herein, we evaluated post-operative drain output volumes to detect differences based on operative approach. Methods A total of 151 patients had IPP placement by a single surgeon between November 2017 and November 2019. After excluding patients who underwent additional procedures for Peyronie's disease, those who had a concomitant procedure for post-prostatectomy stress urinary incontinence, or those who underwent a revision procedure, 133 patients remained. 104 of these had their drain removed on postoperative day three. Of these, drain output data was available for 37 patients. Drain output volumes were evaluated based on surgical approach and compared using a one-way ANOVA statistical analysis. Results Granular drain output data was available for 37 patients. 8 of these patients underwent IPP placement by infrapubic approach, 13 underwent IPP placement by penoscrotal approach, and 16 patients underwent IPP placement by subcoronal approach. Patients who underwent infrapubic IPP placement trended towards increased drain output compared to those who underwent placement via a penoscrotal or subcoronal approach. These observations did not achieve statistical significance. At 72 hours post-op, drain output among all three groups was comparably low. Conclusions As previously demonstrated, an extended post-operative drain duration of three days is not associated with an increased risk of infection in patients undergoing IPP implant. Especially in patients undergoing IPP placement via infrapubic approach, drain output was significant until approximately 72 hours post-op. This data supports the utility in keeping a post-surgical drain for three days in order to maximize drainage and minimize postoperative discomfort. Given the low volume output across all three groups at 72 hours post-op, post-surgical drainage for greater than 3 days is not likely to provide additional benefit. Disclosure No