Application of gelatin sponge (Gelfoam®) as a hemostatic agent in inflatable penile prosthesis implantation

Hematoma formation is one of the complications of inflatable penile prosthesis implantation (iPP), possibly indicating surgical evacuation, or resulting in infection and removal of the implant. Gelatin Sponge (Gelfoam®, Pfizer, USA) is sterile compressed sponge, used as a hemostatic agent, directly applied to bleeding surfaces. It is water insoluble, but absorbable within 4-6 weeks with minimal scar formation. In this study, we evaluate the use of Gelfoam® for control of hemostasis and minimizing post-operative bleeding in iPP surgery. Fifty-eight patients were enrolled into one of two groups according to their will, documented in the consent form: the Gelatin Sponge (GS) group (n = 22), and the control group (n = 36). Following cylinder insertion, corporotomies were closed by tying the stay sutures. For the GS group, Gelfoam® was applied to the closed corporotomies, pump space and reservoir track. A closed suction drain was inserted for all cases and monitored post-operatively. Mummy wrap was not used to evaluate Gelfoam® independently. Patients were monitored for drain output and complications. The mean drain output was significantly higher in the control group compared to GS group, both for the first 24 h (156.7 cc ± 91.6 cc vs. 45.9 cc ± 36.9 cc, 70.7% difference, p < 0.0001) and 24-48 h (40.7 cc ± 42.4cc vs. 8.6 cc ± 12.6 cc, 78.8% difference, p < 0.0001). No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered in the GS group, compared to two cases of hematoma in the control group, one of which dictated drainage (2/36). The findings herein demonstrate the safety and tolerability of Gelfoam® in iPP surgery, as well as its efficacy in minimizing post-operative bleeding.