Expert Training with Standardized Operative Technique Helps Establish a Successful Penile Prosthetics Program for Urologic Resident Education

Abstract

Introduction The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. Aim To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. Methods A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Main Outcome Measures Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Results Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05). Conclusions These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery.

A Review of Surgical Techniques for Impending Distal Erosion and Intraoperative Penile Implant Complications: Part 2 of a Three-part Review Series on Penile Prosthetic Surgery

“…Mechanical reliability is so outstanding that many experts suggest that more penile prosthesis revisions are required for nonmechanical than mechanical reasons [15]. Therefore, much consideration has been taken in an effort to reduce these nonmechanical problems, e.g., the salvage rescue, use of nonsynthetic material for repairs, and the revision washout, all appear to reduce infection rates [16–21].…”

3D pelvic cadaver model: a novel approach to surgical training for penile implant surgery

“…Last but not least, training and surgical education takes place in centres of excellence under direct supervision of high-volume dedicated surgeons. Once trainees have completed this training module they can become safety certified to offer their patients these types of interventions [1][2][3][4][5][6].…”

“…The platform is also able to demonstrate important surgical errors including: perforation of the corporal bodies, injury to iliac vessels, and injury to urethra. The development of these 3D models is an ongoing process since improvements can be incorporated anytime [6,7].…”

Opinion: Why I prefer the penoscrotal access

“…The type of prosthesis to be implanted, inflatable or malleable, depends mainly on the economic condition of the patient, because the high cost of inflatable implants compared to malleable. Other factors may also influence the choice of the type of prosthesis, such as the capacity and ability of the patient to manipulate the scrotal pump, the surgeon's experience ( 2 ), specific clinical cases ( 3 ) and patient preference.…”