120 Drain Use During Penile Prosthesis Surgery, Results from the PROPPER Study

There is minimal data to evaluate the safety of closed suction drain use during penile prosthesis (PP) surgery. We sought to evaluate the safety of using drains during PP surgery from a prospective study. Data from the IRB-approved Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER), a large prospective dataset including data from 13 North American sites, was collected. The registry includes data on patient's baseline characteristics, erectile dysfunction (ED) etiology, surgical and peri-operative management strategies. Patients were stratified into two groups of “Drain” or “No Drain” used during PP surgery. Data from 1348 patients was analyzed with 634 (47%) patients with Drain and 714 (53%) patients with No Drain. The primary ED etiology, implant model and surgical dressing (compression/Mummy wrap) used were no different between the two groups (p>0.05). However, drains were used more commonly in infrapubic approaches, original (virgin) surgeries, when significant corporal fibrosis was noted, with concurrent procedures and curvature correction procedures. Operative time was greater with drain placement (57.8 vs 43.7 min, p=0.001). There was no difference in abscess formation, adhesion of pump, cellulitis, device infection, penile edema, pump migration, pain/discomfort, superficial wound infection or wound dehiscence between both groups (p> 0.05). Ironically, there were 4 scrotal hematomas in the Drain group and none in the No Drain group (p= 0.034). In these 4 patients, the operative time was longer than average (64 min vs 57.8 vs 43.7 min, p= 0.005). All were virgin implants, 2 after RRP, 1 with diabetes and 1 other. Only one patient had a concurrent procedure (circumcision), 2 were done with an infrapubic approach and 2 were penoscrotal approach. All 4 patients were managed conservatively and only one patient is using his devices at 2 year follow-up.