Early clinical outcomes of the "drain and retain" maneuver in inflatable penile prosthesis revision surgery: a multi-institutional review.

Abstract

Background: Urologic prosthetic reservoirs (UPRs) can become firmly adherent to surrounding structures, making their removal during revision surgeries risky. Over the past decade, the "drain and retain" maneuver has been increasingly adopted to safely leave decommissioned UPRs in place. However, outcomes associated with this technique and its safety remains controversial, with ongoing debate in the literature.

Aim: To evaluate the efficacy and safety of the "drain and retain" maneuver using a contemporary, retrospective multi-institutional cohort.

Methods: We reviewed records of patients who underwent inflatable penile prosthesis surgery at seven high-volume penile implant centers in the United States between July 2016 and September 2024. We compared revision cases involving subtotal device removal with "drain and retain" to those with complete component removal and exchange. Cases involving explantation for infection or revisions that reused the original reservoir were excluded. Postoperative complications and infection rates were assessed and compared between groups.

Outcomes: Rates of short-term postoperative infection, non-infectious adverse events, and complications related to retained reservoirs.

Results: 233 cases were included. Among those, 112 (48.1%) used the "drain and retain" technique, while 121 (51.9%) involved complete reservoir removal. The mean follow-up duration was 12.6 months. No complications were attributed to the retained reservoirs. There were no statistically significant differences between groups in postoperative infection rates (P = .940), device malfunction (P = .674), or symptomatic migration of the new UPR (P = .955).

Clinical implications: In this retrospective series with short-term follow-up, decommissioning the reservoir during revision surgery appeared to be a safe approach in the absence of infection; however, these findings may not be reflective of longer-term outcomes.

Strengths and limitations: The strengths of this study include its multi-institutional design and the largest original patient cohort reported to date. Limitations include the retrospective, non-randomized design, relatively short follow-up period, and potential attrition bias, as patients experiencing complications may have sought care elsewhere and were not captured in our database.

Conclusions: Based on short-term data from a retrospective series, the "drain and retain" strategy was associated with early safety outcomes comparable to complete removal while avoiding retropubic dissection, though longer-term outcomes remain unknown.