Multi-institutional outcome study on the efficacy of closed-suction drainage of the scrotum in three-piece inflatable penile prosthesis surgery.

Infection is a devastating complication of penile prosthesis surgery that occurs in approximately 2-5% of all primary inflatable penile primary implants in most series. Prevention of hematoma and swelling with closed-suction drains has been shown not to increase infection rate and yield an earlier recovery time. Despite the intuitive advantages of short-term closed-suction drainage in reducing the incidence of postoperative scrotal swelling and associated adverse effects, many urologists are reluctant to drain the scrotum because of a theoretical risk of introducing an infection. In conclusion, this study was undertaken to evaluate the incidence of infection in three-piece penile prosthesis surgery with scrotal closed-suction drainage. A retrospective review of 425 consecutive primary three-piece penile prosthesis implantations was performed at three institutions in New Jersey, Ohio, and Arkansas from 1998 to 2002. Following the prosthesis insertion, 10 French Round Blake (Johnson & Johnson) or, in a few cases, 10 French Jackson Pratt, closed-suction drains were placed in each patient for less than 24 h. All subjects received standard perioperative antibiotic coverage. Average age at implant was 62 y (range 24-92 y). Operative time (incision to skin closure) was less than 60 min in the vast majority of cases. There were a total of 14 (3.3%) infections and three hematomas (0.7%) during an average 18-month follow-up period. In conclusion, this investigation revealed that closed-suction drainage of the scrotum for approximately 12-24 h following three-piece inflatable penile prosthesis surgery does not result in increased infection rate and is associated with a very low incidence of postoperative hematoma formation, swelling, and ecchymosis.

Child abuse reports in families with sudden infant death syndrome.

This study investigates the relation between sudden infant death syndrome (SIDS) cases and reports to public child protection service (CPS) agencies of suspected child abuse or neglect prior to the sudden deaths. SIDS data were collected from the Ventura County Medical Examiner's death investigation records of 1981 through 1995. Names of deceased infants, their parents, and any other caretakers who might have been with the infant near the time of death were submitted to the county CPS, where they were referenced for reports of abuse or neglect. A control population of non-SIDS infants and their caretakers were checked in a similar manner. The 150 infants from the control group were compared with 157 SIDS infants; no significant statistical difference was found between groups in the incidence or type of CPS referrals. These findings suggest that screening CPS records for previous referrals is an ineffective method by which to detect infanticides misdiagnosed as SIDS and may cast unwarranted suspicion on otherwise typical SIDS cases.