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

Authors


Adam P. Klausner, MD, Associate Professor & Warren W. Koontz Professor of Urologic Research Director of Neurourology and Voiding Dysfunction, Division of Urology, Virginia Commonwealth University School of Medicine, PO BOX 980118, Richmond, VA 23298-0118, USA. Tel: 804-828-5320; Fax: 804-828-2157; E-mail: apklausner@vcu.edu

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. King AB, Klausner AP, Johnson CM, Moore BW, Wilson SK, and Grob BM. Expert training with standardized operative technique helps establish a successful penile prosthetics program for urologic resident education. J Sex Med 2011;8:2726–2732.

Ancillary