Residents at the University of Maryland Medical System Provide Insight to Learning Infrapubic Approach for IPP Surgery: Relative Benefits but Novel Challenges Exposed in First 15 Cases


Andrew Kramer, MD, The University of Maryland School of Medicine, 29 S. Greene St, Suite 500, Baltimore, MD 21201, USA. Tel: (410) 328-6087; Fax: (410) 328-0595; E-mail:


Introduction.  Emphasis should be placed on assessing resident education. At our institution, the trans-scrotal (TS) approach for inflatable penile prosthesis (IPP) surgery has been widely taught, with infrapubic (IP) approach recently introduced. Feedback and trends on learning a new implant technique is assessed.

Aim.  The aim is to understand the advantages and pitfalls of a surgical approach through residents in training. This will provide insight into resident education for teaching physicians and a framework for understanding how to teach the two approaches.

Main Outcome Measures.  The outcomes measured will be the residents' reflection on the ease of different steps of the infrapubic procedure upon finishing 15 sequential cases as well as feeling about the end result and time it took to complete the operation.

Methods.  Two senior residents with experience of over 100 TS implants recorded impressions on their first 15 infrapubic IPP cases via questionnaire. IPP was compared with TS with regard to reservoir, cylinder, pump placement, surgical exposure, and resident involvement. Scores of 1–5 were given, with 1 implying harder or more difficult, 3 the same, and 5 better or easier.

Results.  Proximal dilatation and cylinder placement remained superior for the IP approach, but distal cylinder placement posed major challenges for the IP surgery. Pump placement was more difficult and remained so for the IP approach, yet reservoir placement was similar. Residents' sense of involvement was superior early on for the IP procedure. Operating room time improved steadily for the IP approach and ultimately was faster than implants placed trans-scrotally.

Conclusion.  The IP approach is quickly learned by residents. Resident placement with the IP approach offers no advantage for the experienced resident. Pump placement and distal dilatation began and remain challenging. Location of corporotomy is the most challenging component and dictates difficulty of dilatation. Residents gain early confidence with the IP approach. Kramer A, and Chason J. Residents at the University of Maryland Medical System provide insight to learning infrapubic approach for IPP surgery: Relative benefits but novel challenges exposed in first 15 cases. J Sex Med 2010;7:1298–1305.