Closed Suction Drain Outputs at 12 and 24 Hours after Virginal Three-Piece Inflatable Penile Prosthesis Surgery
Michel Apoj, BS1; Mark Biebel, MD1; Archana Rajender, MD1; Dayron Rodriguez, MD, MPH1; Martin Gross, MD2; Ricardo Munarriz, MD1
1Boston University School of Medicine, Boston, MA; 2Dartmouth-Hitchcock Medical Center, New Hampshire, NH
BACKGROUND: There is no consensus on the use of closed suction drains after inflatable penile prosthesis (IPP) surgery. Proponents of drain usage suggest that drains decrease hematoma formation, scrotal swelling and postoperative pain. Opponents cite concerns of drain fracture and increased infection rates given the presence of an additional foreign body. No increased infectious complications have been reported with the use of closed suction drainage and early removal of scrotal drains has been advocated to decrease theoretical risk of infection. In the non-urologic literature, drain output has been found to be greatest during the first 12 hours following surgery. To our knowledge, no reports of temporal drain output exist in the current IPP literature. As a result, we explored our rates of closed suction drain output at 12 and 24 hours after IPP surgery.
METHODS: We performed a single-institution retrospective review of closed suction drain outputs in primary three-piece IPP cases performed between 2014 and 2017 by a single surgeon. All patients underwent intraoperative placement of a 10 French Jackson Pratt (JP) closed-suction drain in the scrotum. Patients also underwent postoperative compressive dressing using a 4-inch Kerlix TM dressing roll applied to the penile shaft and scrotum in the standard Mummy Wrap fashion. All devices were left fully inflated until drain removal on postoperative day 1. The main outcomes evaluated were the drain outputs at 12 and 24 hours postoperatively. Secondary end points were 30-day postoperative hematoma formation and IPP infections.
RESULTS: 169 IPPs were placed during the study period, of which 165 (98%) had drain outputs recorded at both 12 and 24 hours. The total 24-hour postoperative drain output ranged from 30 to 570 mL (median 132.5 mL, mean 163.5). The mean JP output rate in the first 12 hours postoperatively was 11.0 mL/hour. The mean JP output rate in the second 12-hour period postoperatively was 2.5 mL/hour. No 30-day hematoma formation or infectious complications were noted in this cohort.
CONCLUSIONS: Despite intraoperative and postoperative advancements in IPP surgery, including small corporotomies, compressive dressing usage and postoperative device inflation, there appears to be significant drain output in the first 24 hours postoperatively in our cohort. Based on our data, we advocate for the use of closed suction drains for at least 12 hours postoperatively as this was when outputs were highest (4.4 times higher than in the second 12 hours). Additionally, in our study, the use of JP drains was not associated with any infectious complications or hematoma formation. Randomized prospective studies evaluating drain placement versus no drainage are still required to further elucidate the value and risks of drain placement.
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