Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Abstract

Abstract Background: Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. Materials and Methods: A retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis (IPP)implantation at 2 high volume implant centers was conducted. Cases were defined as ‘complex’ if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Results: Of 246 men who underwent IPP, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although patients in the complex group had 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), hematomas in the complex group had a higher propensity for OR evacuation (p=0.03). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Postoperative hematoma formation in complex cases (5/52, 9.6%) trended towards a higher incidence than primary cases (7/194, 3.1%) (HR=2.61, p=0.072). Conclusions: Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.