Shaeer, O

Penile prosthesis, penile implant, Gelfoam, gelatin sponge, hemostatic agent, drain

1. Introduction

Gelfoam® Sterile Compressed Sponge is a hemostatic that is directly applied to bleeding surfaces. It is prepared from purified porcine skin, Gelatin granules and Water for Injection. It is water insoluble, however is completely absorbed within 4-6 weeks with minimal scar formation 1. Gelfoam is available sterile for intra-operative use, and is applied in a multitude of surgical specialties2-4. In this work, we demonstrate for the first time the of Gelfoam to minimize the risk of bleeding in penile prosthesis implantation.

2. Case presentation

Eight cases received a three-piece inflatable implant (Rigicon Infla10®) through a peno-scrotal incision

3. Protocol

Following cylinder insertion, corporotomies were closed by tying the stay sutures rather than water-tight sewing. Gelfoam was soaked in antibiotic-supplemented saline. Air bubbles were squeezed out followed by soaking. Gelfoam was then applied to the corporotomies, pump space and entry rout to the reservoir space. It was secured over the corporotomies by closing a pre-fashioned layer of Buck’s fascia. A suction drain was inserted. Mummy wrap was not used. Drain output was monitored and complications recorded.

4. Outcome

In two cases, drain output was an average of 80 cc’s in the first 24 hours, then 20 cc’s in the following 24 hours. However, in 6 cases, drain output was an average of 18 cc’s in the first 24 hours, mostly sero-sanguinous, then none in the following 24 hours. No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered.

5. Discussion

An injectable hemostatic matrix was previously tested for securing hemostasis. The matrix is injected into the corporotomies before quickly tying the last suture to avoid loss of the matrix. The positive results had the authors recommend the technique to replace drains and mummy wraps 5.

The initial results of the current small case series demonstrate that Gelfoam is well-tolerated in penile surgeries, with possible value at minimizing post-operative bleeding, encouraging a multi-center larger study.

[1] Pfizer. Gelfoam®. https://cdn.pfizer.com/pfizercom/products/uspi_gelfoam_plus.pdf

[2] Hayashi K, Nakazawa T, Yoshida M, et al. [Case report; usefulness of gelatin sponge for bile leakage from hilar bile duct after right hepatic lobe resection]. Nihon Naika Gakkai Zasshi. 2011;100: 2266-8.

[3] Liang J, Liu H, Huang X, et al. Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: A randomized control trial. Clin Neurol Neurosurg. 2016;147: 110-4.

[4] Vasli S. [Gel-foam in the treatment of subcutaneous rupture of the liver]. Nord Med. 1950;43: 598-9.