“Drain and retain” technique appears safe in IPP revision surgery

The “drain and retain” technique of leaving decommissioned urologic prosthetic reservoirs in place during inflatable penile prosthesis (IPP) revision surgery appears to be safe, according to study findings presented at the 2024 Sexual Medicine Society of North America Fall Scientific Meeting in Scottsdale, Arizona.¹

Thairo Pereira, MD

“It's very well established in the literature that when there is an infection present, we should remove all the components of the IPP. However, in the absence of an infection, this might not be necessary, and the reason for that is because removing the reservoir can be time consuming, and there is some significant morbidity involved…To avoid potential morbidity, a few reports in the past few years have described the idea of leaving the old reservoir decommissioned inside the pelvis during revision surgeries with a minimal subsequent risk of infections,” explained presenting author Thairo Pereira, MD, the outgoing andrology fellow at Indiana University in Indianapolis.

To evaluate the safety of the drain and retain method, Pereira and his colleagues looked at 7 busy penile implant centers in the US from July 2016 to June 2024. Patients were stratified into 3 groups: patients who had their reservoir removed, patients in whom drain and retain was used, and primary IPP surgery, which was the control group.

A total of 1201 primary IPP placements and 231 revision procedures were included in the study. Of the revision cases, 112 (48.5%) fell into the drain and retain category, whereas 119 (51.5%) were reservoir removal cases. The investigators postoperative infection rates of 3.2%, 2.5%, and 2.7% in the primary IPP surgery, reservoir removal, and drain and retain groups, respectively (P = .897).

“There was no statistic difference regarding age, [body mass index], and smoker status, as well as comorbidities like diabetes, hypertension, and a history of prior prostatectomy or prior radiation,” Pereia said.

Pereira noted that the study is limited by its retrospective nature. In addition, he speculated that the study’s low complication rate may point to it being underpowered due to sample size.

“In the absence of infection, [drain and retain] is a safe strategy without further complications compared to the primary groups…Drain and retain avoids the potential morbidity of dissection into the retropubic space, maintaining the infection rates and complication rates comparable to primary IPP cases,” Pereira said in his concluding remarks.

REFERENCE

1. Pereira TA, Rust JO, Good J, et al. Contemporary findings regarding the efficacy and safety of the “drain and retain” maneuver for urologic prosthetic reservoirs during inflatable penile prosthesis revision surgery. Presented at: 2024 Sexual Medicine Society of North America Fall Scientific Meeting. October 17-20, 2024. Scottsdale, Arizona. Abstract 019