Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience

Objective To present our 5-year experience using a "drain and retain" option, in which existing urologic prosthetic balloons and reservoirs (UPBR) were emptied but not removed during routine artificial urinary sphincter (AUS)/inflatable penile prosthesis (IPP) reoperation. Methods All genitourinary prosthetic surgeries by a single surgeon from July 2007 to September 2012 were reviewed. Patients were included in the study group if they underwent prosthetic replacement (with contralateral new UPBR placement) or subtotal device removal, although having their original UPBR drained and retained. Virgin cases, complete device removals for gross infection, and revision cases using the original UPBR were excluded. The "drain and retain" technique involved defunctionalizing the existing UPBR by aspirating all its fluid, placing the tubing on traction, and cutting proximally. Postoperative outcomes with specific attention to infection were reviewed and compared with patients receiving their first prosthesis (control group). Results A total of 551 urologic prostheses (251 AUS and 300 IPP) were inserted in 433 men during the 5-year study period. Among 120 reoperative prosthetic cases, UPBR were drained and retained in 55 (46%). The control group consisted of 352 patients undergoing initial AUS (154 cases) and/or IPP (236 cases) placement. No difference in infection rate was identified between the control group (6 of 390; 1.5%) and the "drain and retain" group (1 of 55; 1.8%; chi-square = 0.024; P =.88). Conclusion Retention of defunctionalized uninfected genitourinary prosthetic balloons and reservoirs does not increase complication rate during reoperative AUS and/or IPP surgery.