LAUSR

In this paper, Apoj et al. present their data from a singleinstitution, single-surgeon, retrospective study on the outcomes of closed suction drain (CSD) placement during primary inflatable penile prosthesis (IPP) implantation [1]. In their series of 169 IPP implantations with CSD placement from 2014 to 2017, the authors retrospectively reviewed postoperative drain outputs for 166 cases at 12 and 24 h and noted postoperative complications such as hematoma formation and prosthesis infection up to 30 days post implantation. All patients received an antibiotic-coated three-piece Coloplast IPP with the same hemostatic operative technique and received the “mummy wrap” compressive dressing to reduce hematoma formation [2, 3]. A ten French Jackson Pratt (JP) CSD was used in all cases and placed in the scrotum via a stab incision. The authors report no hematoma formation and infections during the 30-day postoperative period in their series, consistent with the low reported hematoma formation rates of 0.2–3.6% and infection rates of 0.5–5.3% in the literature [4]. The authors, however, do report high average drainage outputs of 162.1 ml at 24 h, when compared to the average of 65 ml reported by Sadeghi et al. prior to drain removal [5]. The drainage outputs linearly correlated with operative time, implying that without CSD, longer IPP operations carry a higher risk of fluid accumulation and thus hematoma formation. From their data, the authors contend that routine CSD placement has no increased risk of infection, and should be considered for all IPP implantations, particularly those with expected lengthy operative times to decrease risk of hematoma formation. A few limitations to this study, however, must be highlighted. Outside of its retrospective nature and lack of statistical power acknowledged by the authors, the study draws its conclusions from a short 30-day postoperative follow-up period. While most if not all postoperative hematomas will present within the 30-day window, IPP infection presentation can be delayed, with Fishman et al. demonstrating that 36% of infections can manifest between 7 and 12 months postoperatively [6]. Therefore, the study conclusions would have been more powerful had the follow-up period been longer. Furthermore, in the methods section, the authors do not report the perioperative antibiotic regimen used during IPP implantation. Most surgeons will assert that prosthesis infection prevention is multifactorial, with perioperative antibiotic prophylaxis playing a crucial role [3]. Without knowledge of the antibiotic regimen used in this study, it is difficult to holistically evaluate the role of CSD placement in IPP implantation regarding infection prevention. However, despite its limitations, this study provides an update to the body of work supporting the use of CSD placement during IPP implantation. The authors call for a randomized prospective study that will hopefully provide answers to end the controversy surrounding CSD placement during IPP implantation [3].