Delayed Postoperative Hematoma Formation After Inflatable Penile Prosthesis Implantation

Abstract

Introduction Infrequent but serious postoperative complications following inflatable penile prosthesis (IPP) insertion include infection, malfunction, and bleeding. Although prior publications report methods to reduce immediate postoperative bleeding, there is little in the literature concerning the etiology, diagnosis, imaging, and management of delayed bleeding after IPP insertion. Aim The aim of the study was to review cases of delayed postoperative bleeding following IPP insertion in a large single-surgeon series. Methods We carried out a retrospective chart review of 600 patients implanted with a Coloplast Titan IPP with One-Touch Release pump by a single surgeon, and analyzed cases of delayed postoperative bleeding. Main Outcome Measure The main outcome measure was an analysis of the incidence, causes, diagnostic methods, treatment, and final outcome of these cases. Results Three out of 600 consecutive patients (0.5%) developed a delayed (defined as >5 days postoperative) hematoma following IPP insertion. All patients presented postoperatively with a swollen surgical site, and all were evaluated with a pelvic computed tomography scan to completely define the extent of the hematoma. Two patients developed a delayed hematoma because of excessive physical activity; the remaining patient bled because of premature administration of enoxaparin sodium (Lovenox) by his cardiologist. All three patients were successfully treated with hospital admission, intravenous antibiotics, wound exploration, hematoma evacuation, and antibiotic washout. All three IPPs were successfully salvaged; none developed peri-prosthetic infection. Conclusions The incidence of delayed postoperative hematoma following IPP surgery was 0.5% in our series of 600 cases. All cases were successfully managed with intravenous antibiotics, hematoma evacuation, and antibiotic washout. Because of the low incidence of this complication, definitive statements concerning prevention and management cannot be made. However, we now recommend avoiding postoperative anticoagulants for at least 5 days if possible, and avoiding vigorous physical activity for at least 3 weeks.

30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation

“…Drain placement has not been associated with increased risk of infection ( 39 ). Garber and Bickell ( 40 ) reported a delayed hematoma rate of 0.5% that occurred during the second postoperative week; onset was associated with excessive physical activity and premature use of anticoagulants. The rate of hematoma at 18 months follow up has been estimated at 0.7% ( 39 ).…”

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

“…Pozza and colleagues examined hematoma formation in the immediate post-operative period (post-operative day one) for semi-rigid and inflatable prostheses with and without scrotal drainage ( 34 ). Another study reviewed delayed hematoma formation defined as occurrence after the fifth post-operative day ( 38 ). This study purported to be the only focusing on delayed hematoma formation.…”

“…Post-operative scrotal hematoma in the setting of penile prosthesis implantation is often managed expectantly without further surgical intervention. Conservative management includes a combination of bed rest, scrotal elevation, compression dressing, ice application, and antibiotics ( 38 , 45 ). In one large retrospective study of 955 penile prosthesis implantations, Chung and colleagues reported that penoscrotal bruising was a common occurrence without quantification of frequency, but they did report that none of the hematomas required surgical intervention ( 33 ).…”

“…These patients presented with swelling of the surgical sites more than 5 days post-surgery, and the extent of the hematomas were confirmed by computed tomography (CT) scan. These patients underwent wound exploration with surgical evacuation, antibiotic washout, and parenteral antibiotics with resolution of hematoma ( 38 ). Levine et al also reported successful surgical evacuation of a post-operative hematoma without further complications ( 41 ).…”

Complications and Problems of Penile Prosthetic Surgery in a Series of 530 Cases Operated on by the Same Surgeon in Italy

“…Other complications involve the reaction of the tissues affected by the implant, with the development of oedema, lymphangitis (10), scrotal effusion, serous and bloody effusion (11,12),local and regional hyposensitivity, reduced shaft size and urinary problems, which may require further surgery, with no guarantee of success.…”