Parikh Dr. Niki, Roshandel Dr. Reza, Griggs Dr. Ryan, Henry Dr. Gerard, Perito Dr. Paul, Kohler Dr. Tobias

(40) BLOOD THINNERS: DO THEY NEED TO BE HELD FOR IPP SURGERY?

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Inflatable penile prosthesis (IPP) placement on active anticoagulation (AC) is controversial. Techniques utilized to decrease complications include use of malleable implant, partial inflation of IPP for hemostasis, and placement of drain; however risk and benefits must be weighed. We sought to assess outcomes of IPP in men on AC in a multi-institutional study. Methods Data from 3 high-volume implant centers was retrospectively analyzed. Demographics, comorbidities, secondary procedures, drain placement/output, and complications were recorded. Aspirin was excluded as it is not routinely held. Center 1 utilizes a penoscrotal approach without drain placement, center 2 a penoscrotal approach with drain placement (removal when output <50 mL/8 hours), and center 3 an infra-pubic approach with drain for 3 days. Results 202 patients were continued on AC throughout surgery: 112 on clopidogrel, 35 warfarin, 38 apixaban, 1 enoxaparin, 15 rivaroxaban, and 1 combination therapy with clopidogrel and enoxaparin. AC was most continued for peripheral vascular disease (55%), cardiac stents (11.6%), CHF (11%), and atrial fibrillation (11%). Nine patients (3.98%) experienced complications. Four significant events (1 retropubic bleed requiring transfusion, 3 IPP infections) and 5 minor events (3 hematomas, 1 wound dehiscence,1 CT-negative stroke) occurred. Average drain output for center 1 was 223 mL with no hematomas or infections noted. Average drain output for center 2 was 121 mL with most drains removed postoperative day 1. Drain output was significantly higher than historical non-AC controls (p=0.001), however complication rates were not significantly different (p>0.05). AC type, revision surgery, scrotoplasty, or reservoir technique did not affect outcomes or drainage. Conclusions In high-volume implant centers, major complication rate of 1.9% occurred in IPP patients on AC. Although IPP is feasible in this patient population, drain for 3 days and submuscular reservoir placement may be indicated. In most, elective IPP surgery should be delayed until it is safe to discontinue anticoagulation. Conflicts of Interest None

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