(082) The Effect of Closed Suction Drain Usage on Postoperative Outcomes After Three-Piece Inflatable Penile Prosthesis Surgery: A Retrospective Comparative Single-Center Study

Introduction Closed suction drain systems are frequently used in penile prosthesis implantation surgery to prevent postoperative hematoma and fluid accumulation; however, concerns exist regarding a potential increase in infection risk. Objective This study aimed to evaluate the effect of drain usage on outcomes in patients undergoing primary three-piece inflatable penile prosthesis surgery. Methods This study, initially planned prospectively but analyzed retrospectively, included patients who underwent primary three-piece inflatable penile prosthesis surgery at our center between September 2020-August 2024. Patients who had additional surgical interventions such as grafting for Peyronie’s disease or simultaneous Wilson maneuver, or those with severe fibrosis due to priapism, were excluded. Patients were divided into two groups: those who had a closed suction drain placed and removed at 24 hours postoperatively, and those without drain placement. A third group consisted of patients whose drains were retained for more than 24 hours due to daily output exceeding 50 ml. Demographic characteristics, comorbidities (diabetes mellitus, vascular disease, Peyronie’s disease, history of radical prostatectomy), surgical features (operative time, Wilson maneuver, prosthesis type), and postoperative complications (hematoma on postoperative days 3 and 10, infection, mechanical problems) were compared. All patients with a history of anticoagulant use were bridged to low molecular weight heparin five days before the procedure. Prostheses were implanted via either penoscrotal or infrapubic approaches. Statistical analysis used the Mann–Whitney U test, Pearson’s chi-square, and Fisher’s exact test as appropriate. Results A total of 431 patients were analyzed: 149 with drains removed at 24 hours, 21 with prolonged drainage, and 261 without drains. Median age was 60(54–66) years. Comparison between the 24-hour drain group and the no-drain group showed no significant differences in age, operative time, comorbidities, or prior surgical history. However, BMI was significantly higher in the drain group (p=0.035). Although smoking rates were higher in the drain group, the difference was not statistically significant(p=0.062). Rates of hematoma, infection, and mechanical complications on postoperative days 3 and 10 were similar between groups (p>0.05). At 12 months, prosthesis malfunction occurred in 15 patients(3.7%). Early postoperative hematoma on day 3 was identified as a significant risk factor for malfunction (OR:4.67,p=0.014), while the presence of vascular disease was associated with a lower malfunction rate (OR:0.14,p=0.025). Infection developed in 2.0% of patients within the first 3 months, with the strongest predictors being hematoma on day 3 (OR: 29.0, p<0.001) and day 10 (OR: 10.6, p=0.002). Factors influencing hematoma development on day 3 included smoking, which increased hematoma risk by 2.3-fold (p=0.021), and lower BMI, which was also significantly associated (p=0.033). Smoking was the most significant risk factor for hematoma on day 10 (OR:2.11, p=0.017). Among the 21 patients followed with drains retained for more than 24 hours, only 2 developed infections within the first 3 months. Conclusions The use of drains in primary three-piece inflatable penile prosthesis surgery did not increase the rates of postoperative hematoma, infection, or mechanical complications, showing no significant differences between groups. These findings suggest that drain placement neither raises the risk of complications nor provides a clear beneficial effect on postoperative outcomes. Disclosure No