Abstract Background Three-piece penile prosthesis implantation (PPI) is the gold standard treatment for refractory erectile dysfunction. Although infection rates have declined with improved surgical techniques and antibiotic prophylaxis, postoperative hematoma remains an early complication that may predispose to infection and device malfunction. The role of short-term closed-suction drainage in reducing these complications remains controversial. Aim To evaluate whether placement of a 24-h closed-suction drain reduces postoperative hematoma, infection, and mechanical complications following primary three-piece PPI surgery. Methods This retrospective comparative study included 410 patients undergoing primary penoscrotal three-piece PPI between September 2020 and August 2024. Patients were divided into a drain group (n = 149) and a no-drain group (n = 261). Demographics, comorbidities, operative characteristics, and postoperative outcomes were analyzed. Hematoma was assessed clinically and by ultrasonography on postoperative days 3 and 10. Patients were followed for 12 months. Comparative and multivariate statistical analyses were performed. Outcomes Primary outcomes: Postoperative hematoma and infection. Secondary outcomes: Mechanical complications and risk factors associated with hematoma formation. Results On postoperative day 3, hematoma was detected in 13.4% of the drain group and 8.8% of the no-drain group (P = .143). By day 10, rates were 16.8% and 13.0%, respectively (P = .298). Infection occurred in 2.0% of patients overall, with no difference between groups (P = 1.000). Mechanical complication rates were also comparable (2.7% vs. 4.2%, P = .427). Hematoma formation was significantly associated with infection (postoperative day 3, OR: 29.0; P .001; day 10, OR: 10.6; P = .002) and prosthesis malfunction (OR: 4.67; P = .014). Smoking and lower body mass index were identified as independent risk factors for hematoma development. Clinical implications Routine placement of a 24-h closed-suction drain does not appear to be associated with a reduction in postoperative complications after PPI. Preventive strategies should focus on meticulous intraoperative hemostasis and optimization of modifiable patient-related risk factors such as smoking. Strengths and limitations The study includes a relatively large cohort and standardized ultrasonographic assessment. However, its retrospective design, exclusion of complex cases, and lack of standardized hematoma grading limit generalizability and causal inference. Conclusions Routine use of a 24-h closed-suction drain in primary three-piece PPI surgery is not associated with a reduction in hematoma, infection, or mechanical complications. Hematoma formation remains a key determinant of adverse outcomes, emphasizing the importance of careful surgical technique and patient optimization rather than routine drainage.
Ortaç et al. (Fri,) studied this question.