Braun Avery E, Swerdloff Daniel, Sudhakar Architha, Patel Rutul D, Gross Martin S, Simhan Jay
Department of Urology, University of California San Francisco, San Francisco, CA, USA.
Department of Urology, Northwell Health, Brooklyn, NY, USA.
Int J Impot Res. 2025 Jan;37(1):82-86. doi: 10.1038/s41443-023-00697-2. Epub 2023 May 8.
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. This was a retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis implantation at 2 high volume implant centers. 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. Of 246 men who underwent penile prosthesis surgery, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although hematoma formers in the complex group had comparable drain outputs to primary patients on postoperative day 0 (66.8cc ± 32.5 vs 48.4 ± 27.7, p = 0.470) and postoperative day 1 (40.3cc ± 20.8vs 21.8 ± 11.3 p = 0.125), hematomas in the complex group had a higher propensity for OR evacuation (p = 0.03). Difference in duration of temporary device inflation between 2 (64, 26%) and 4 weeks (182, 74%) did not contribute to hematoma formation (p = 0.562). The incidence of postoperative hematoma formation in complex cases was 9.6% (5/52) and 3.6% in primary cases (7/194) (HR = 2.61, p = 0.072). 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.
阴囊血肿是阴茎假体手术中一种具有挑战性的并发症。我们通过实施标准化技术来减轻血肿，并在一个大型多机构阴茎植入队列中评估任何相关因素，以此来描述血肿形成的风险。这是一项对2018年2月至2020年12月期间在2个高容量植入中心接受可膨胀阴茎假体植入的所有患者的回顾性研究。如果病例涉及翻修、移除/更换挽救手术，或与阴茎、阴囊或腹部同期手术，则定义为“复杂”病例。测量了初次和复杂可膨胀阴茎假体接受者中阴囊血肿的发生率，并追踪了与两个队列中血肿形成相关的可改变和固有风险因素。在246例接受阴茎假体手术的男性中，194例（78.9%）患者接受了初次植入，52例（21.1%）为复杂病例。虽然复杂组血肿形成者术后第0天（66.8cc±32.5 vs 48.4±27.7，p = 0.470）和术后第1天（40.3cc±20.8 vs 21.8±11.3，p = 0.125）的引流量与初次手术患者相当，但复杂组血肿更倾向于进行手术清除（p = 0.03）。临时装置充气持续时间在2周（64例，26%）和4周（182例，74%）之间的差异对血肿形成无影响（p = 0.562）。复杂病例术后血肿形成的发生率为9.6%（5/52），初次病例为3.6%（7/194）（风险比=2.61，p = 0.072）。为翻修或辅助手术进行的复杂可膨胀阴茎假体手术更有可能导致需要手术处理的具有临床意义的血肿，这表明在管理这些患者时需要格外谨慎。
