Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery

Abstract

Infection is a devastating complication of penile prosthesis surgery that occurs in approximately 2-5% of all primary inflatable penile primary implants in most series. Prevention of hematoma and swelling with closed-suction drains has been shown not to increase infection rate and yield an earlier recovery time. Despite the intuitive advantages of short-term closed-suction drainage in reducing the incidence of postoperative scrotal swelling and associated adverse effects, many urologists are reluctant to drain the scrotum because of a theoretical risk of introducing an infection. In conclusion, this study was undertaken to evaluate the incidence of infection in threepiece penile prosthesis surgery with scrotal closed-suction drainage. A retrospective review of 425 consecutive primary three-piece penile prosthesis implantations was performed at three institutions in New Jersey, Ohio, and Arkansas from 1998 to 2002. Following the prosthesis insertion, 10 French Round Blake (Johnson & Johnson) or, in a few cases, 10 French Jackson Pratt, closed-suction drains were placed in each patient for less than 24 h. All subjects received standard perioperative antibiotic coverage. Average age at implant was 62 y (range 24-92 y). Operative time (incision to skin closure) was less than 60 min in the vast majority of cases. There were a total of 14 (3.3%) infections and three hematomas (0.7%) during an average 18-month follow-up period. In conclusion, this investigation revealed that closed-suction drainage of the scrotum for approximately 12-24 h following three-piece inflatable penile prosthesis surgery does not result in increased infection rate and is associated with a very low incidence of postoperative hematoma formation, swelling, and ecchymosis.

Use of BioPatch® (Protective Disk with Chlorhexidine Gluconate) in Closed-Suction Drainage for Penile Implant Surgery

“…The hematoma rate has been showed to decrease from 3 to 0.7% when combining the use of pressure dressing, drainage and partial inflation [17]. This is not surprising in light of data showing an average drainage volume of 65 ml when using CSD [16]. …”

“…Detractors of CSD use in penile prosthesis surgery refer to data showing that the infection rate is no different with placement of CSD than those accepted in the literature: 3.3% versus the reported 2-5% [16]. Additionally, the formation of hematoma has not been proved to be statistically significantly lower with CSD [17].…”

Penile Prosthesis Infection: Progress in Prevention and Treatment

“…The incidence of implant infection does not seem to be affected by the incision site, brand of prosthesis, number of components, excessive body fat, or prior pelvic irradiation. To use drains or not to use drains does not change the chance of infection developing after implant placement [13]. If phimosis of the prepuce is present, a circumcision should be performed at a procedure to eliminate the underlying smegma before implant placement.…”

Updates in Inflatable Penile Prostheses

“…A multiinstitutional study recently showed that putting on the compressive ''spider web'' tape dressing and placing a drain seems to reduce the rate of significant hematomas to about 1% [52]. Some frequent implanters adopt another approach to avoid hematomas.…”

“…In an attempt to avoid postoperative hematoma, Sadeghi-Hejad and colleagues [52] conducted a multi-institutional study on the efficacy of closed-suction drainage of the scrotum in three-piece IPP surgery. This study of 425 patients was used to put an end to the debate of whether closed suction drainage increased the incidence of infection.…”