Postoperative management after penile fracture surgery: Intraoperative drainage is not associated with early morbidity reduction after penile fracture repair (FRACT AFUF project).
Norbert De Brek, Arthur Peyrottes, Charles Dariane, Maxime Pattou, Alexandra Clerget, François Desgrandchamps, Paul Sabbagh, Hugo Dupuis, Louise Duffaut, Igor Duquesne, Benoît Mesnard, Capucine Miquel, Martin Lorette, Ophélie Delchet, Adrien Boileau, Stéphan Levy, Alice Bourillon, Anna Goujon, Valentine Lethuillier, Antoine Faix, William Mathez, Gabrielle Tissot, Alexandre De La Taille, Céline Mardelli, Grégory Papin, Arthur Galano, Thibaut Waeckel, Charly Bacle, Aurélie Schirmann, Élodie Chauveau, Pascal Eschwege, Jefferson Gardet, Philippe De Sousa, Angèle Reichenbach, Paul Neuville, Maxime Chabenes, Gaelle Fiard, Thomas Bessede, Cédric Lebacle
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引用次数: 0
Abstract
Purpose: Penile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intraoperative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair.
Methods: We performed a retrospective multicenter study including all patients with surgically confirmed corpus cavernosum fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intraoperative drain placement. The primary outcome was any early postoperative complication within 30days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Hospital stay and symptoms at 1 and 3months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral or bilateral injury and surgeon experience assessed associations with complications.
Results: Among 457 patients, 153 (34%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 11%. Drain placement was not significantly associated with complications (OR: 1.18; 95% CI: 0.59-2.29; P=0.63), whereas urethral injury was (OR: 2.33; 95% CI: 1.06-4.91, P=0.03). At 1month, 63% of patients reported at least one symptom and sexual pain was more frequent in the drain group (25% vs. 18%; P=0.04). Interpretation is limited by retrospective design and loss to follow-up.
Conclusion: Intraoperative drainage was not associated with reduced early morbidity and was associated with a longer hospital stay and more sexual pain at 1month. Although these findings do not support the routine use of drains after penile fracture repair, our study does not exclude a potential benefit in selected complex cases. Drain use should therefore be tailored to intraoperative findings.
目的：阴茎骨折是一种罕见的泌尿外科急诊。然而，由于证据有限，术中引流的指征仍存在争议。本研究旨在评估引流对阴茎骨折修复术后并发症和症状的影响。方法：我们在法国21个中心进行了一项回顾性多中心研究，包括2000年至2024年间所有手术证实的海绵体骨折患者。根据术中引流管放置情况对患者进行分层。主要结局是术后30天内的任何早期并发症（血肿、手术部位感染、伤口裂开、疼痛性水肿、皮肤坏死或尿潴留）。关键的次要结局是手术部位的并发症（血肿、手术部位感染或伤口裂开）。住院时间、1个月和3个月时的症状也进行了评估。多变量logistic回归校正了手术入路、尿道或双侧损伤以及外科医生经验与并发症的关系。结果：457例患者中153例（34%）接受引流。引流管放置与较长的手术时间和住院时间以及更频繁的脱手套入路有关。术后总并发症发生率为11%。引流管放置与并发症无显著相关性（OR 1.18; 95% CI 0.59-2.29; p =0.63），而尿道损伤与并发症有显著相关性（OR 2.33; 95% CI 1.06-4.91, p = 0.03）。1个月时，63%的患者报告了至少一种症状，引流组的性疼痛更频繁（25% vs 18%; p = 0.04）。解释受到回顾性设计和随访缺失的限制。结论：术中引流与降低早期发病率无关，与1个月住院时间延长和性疼痛增加有关。虽然这些发现不支持阴茎骨折修复后常规使用引流管，但我们的研究并不排除在某些复杂病例中潜在的益处。因此，引流管的使用应根据术中发现进行调整。
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