Presentation Authors: Alfredo Suarez-Sarmiento Jr.,*, Matthew Brennan, Alfredo Suarez-Sarmiento, Paul Perito, Coral Gables, FL
Introduction: There are limited studies that look at how a subset of patients undergoing Inflatable Penile Prosthesis (IPP) implantation while on anticoagulant therapy fair post-operatively. IPP is commonly indicated for patients who suffer from atherosclerotic cardiovascular disease (ASCVD), yet some patients cannot temporarily discontinue their anticoagulants for surgery. We sought to evaluate our dual institutional experience to determine factors associated with post-operative outcomes.
Methods: Patients undergoing IPP implementation while on anticoagulant therapy from 2014 to 2018 were identified from our dual institutional databases. All clinical notes, patient demographics, comorbidities and surgical outcomes were reviewed. Anticoagulant medications were not altered at the time of surgery and patients were given full disclosure of bleeding risk during surgery. For the purpose of this study, patients were followed for post-operative metrics of wound closure, infection, pain and swelling. All patients underwent either penoscrotal or infrapubic placement of IPP with post-operative drains in place.
Results: 110 patients were identified as being on anticoagulant therapy at the time of IPP placement. Our results showed that 108 (98.2%) of our cohort had uncomplicated post-operative courses. We found that these patients did not have excessive infrapubic or scrotal hematoma requiring further drainage or hospitalization. Only 2 patients in our population had an adverse event post-operatively and both patients were on warfarin. Both patients were readmitted and required transfusions without reoperation.
Conclusions: IPP implantation may be safely completed in the setting of anti-platelet therapy without increased blood loss, hospital stay, or complication rate. With meticulous dissection and closure of corporotomy and the use of a drain for 1-3 days, we observed no increased risk. Informed consent of risk and reward is mandatory, and measures must be taken to ensure that compulsive homeostasis is being performed in this subset of patients. Patients maintained on vitamin K dependent therapies may be better served with bridging.