To Drain or Not To Drain an Inflatable Penile Prosthesis Implantation? A Multi-institutional Experience Tracking Scrotal Hematoma and Infection Occurrence

Abstract

ABSTRACT Introduction Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection. Objective We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration of drainage. Methods Our subjects underwent IPP implantation by four European high volume surgeons. All implantations were performed via the penoscrotal access. Only virgin cases were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics according to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days. Results There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free. Conclusions Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast