Defining the Incidence of Postoperative Scrotal Hematoma After Three-piece Inflatable Penile Prosthesis Surgery
Rutul D. Patel, MBS1, Avery E. Braun, MD2, Architha Sudhakar, MD2, Jacob W. Lucas, MD2, Martin S. Gross, MD3, Jay Simhan, MD2.
1New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA, 2Einstein Healthcare Network, Philadelphia, PA, USA, 3Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Development of scrotal hematoma is a rare but serious complication following inflatable penile prosthesis (IPP) surgery. Multiple techniques to mitigate hematoma formation are implemented by penile implant surgeons, including temporary device inflation, Mummy wrap usage, drain placement and appropriate suspension of anticoagulation (AC). We assessed the incidence of scrotal hematoma formation in primary and complex IPP recipients managed with these techniques.
This is a multicenter retrospective review of 246 patients from 2/2018 to 12/2020 with 194 (78.9%) primary and 52 (21.1%) complex IPP surgeries. Revisions, removal/replacements, or IPPs with concomitant procedures were considered complex. All patients underwent surgery with appropriate suspension of AC as well as postoperative Mummy wrap and drain placement. Drain outputs on postoperative day (POD) 0 and 1 were collected. Device activation varied between two and four weeks, based on surgeon preference. Incidence of postoperative bleeding with hematoma formation was assessed along with risk factors and postoperative management.
Primary and complex IPP hematoma patients were similarly matched groups compared to non-hematoma formers. The incidence of postoperative hematoma formation in complex cases (5/52, 9.6%) is more than double that of primary cases (7/194, 3.1%) (HR=2.61). Complex IPP hematomas have a higher propensity for OR evacuation than primary hematomas (p=0.028). AC status impacted 25% (3/12) of hematoma formers with 40% (2/5) of complex hematomas related to AC resumption (HR=2.40). Patients with scrotal hematomas had increased pain on the postoperative night immediately following surgery (Visual Analog, VAS, score 5.3 vs 3.2, p=0.012). However, hematoma formers had similar VAS scores in PACU (2.7 vs 1.9. p=0.485) and POD1 (4.5 vs 3.4, p=0.316) and comparable drain outputs to non-hematoma patients on POD0 (66.8cc vs 49.6, p=0.488) and POD1 (20.0cc vs 40.3, p=0.114). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Penoscrotal approach accounted for 6/12 (50%) of hematomas (p=0.298).
Complex IPP surgeries (revisions or concomitant cases) are more likely to result in hematoma requiring OR management with anticoagulated status as an associated risk factor. It may be prudent to manage complex IPP cases with prolonged drainage along with an increased duration of holding postoperative anticoagulation.
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