(036) EMERGING DATA REGARDING THE INFLUENCE OF INTERESTED RESIDENTS ON PENILE PROSTHESIS SURGERY OUTCOMES
Authors: Atwater BL , Gross MS , Madden-Fuentes RJ 
Published: December 2024

Abstract

Introduction
The current penile prosthesis literature suggests that inflatable penile prosthesis (IPP) surgeries involving residents have similar outcomes and complications as compared to cases performed with nonresident assistants. Aside from this there is scant literature exploring IPP outcomes in surgeries involving residents and virtually no literature comparing different resident populations. This is the first evaluation comparing IPP outcomes for residents with and without interest in pursuing a career in sexual medicine.

Objective
The primary objective was assessing whether overall operative time and complication rates were different between resident cohorts with and without interest in a future career in sexual medicine.

Methods
A multicenter retrospective review was performed including patients undergoing primary IPP insertion from 2017-2024 with residents as assisting surgeons. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) or a Boston Scientific AMS CX or LGX IPP (Boston Scientific, Marlborough, MA, USA) implanted. Operative times, intraoperative complications, postoperative complications, and postoperative emergency room visits were analyzed. Revision cases, concomitant surgeries, and cases with nonresident assistants were excluded. Residents with an interest in sexual medicine were defined as those planning to enter a Sexual Medicine Society of North America (SMS) fellowship. Rigorous statistical analysis was performed using Microsoft Excel (Microsoft, Redmond, WA, USA).

Results
A total of 128 patients at two institutions were included. There were 11 individual residents who participated in the cases, 2 of whom were interested in pursuing fellowship in male sexual medicine (SMS residents). Patient demographics and case characteristics were similar between groups, with no statistically significant differences. Case volumes were similar between SMS residents and non-SMS residents. The mean operative time was 89 ± 44 minutes for SMS residents and 89 ± 28 minutes non-SMS residents (p = 0.976). There was one intraoperative complication for each cohort (right proximal perforation in the SMS group and severe fibrosis necessitating placement of a malleable device in the non-SMS group, p = 0.453). Cases with SMS residents had a postoperative Clavien-Dindo complication rate of 6.3% (n = 1, hematoma) compared to 13.0% in the non-SMS resident group (n = 6, p = 0.666). Postoperative complications for non-SMS residents included urinary retention (1), reservoir migration (2), malpositioned cylinder (1), and death within 30 days (2). Patients who had surgery with non-SMS resident assistant surgeons were more likely to have postoperative emergency room visits 10.8% (n = 5 vs n = 0, p = 0.315).

Conclusions
This is the first evaluation to date comparing IPP outcomes in cases performed with residents with and without interest in a career in sexual medicine. Although not statistically significant, likely due to cohort size, patients with an assisting surgeon uninterested in pursuing a sexual medicine fellowship had more postoperative complications and emergency room visits. Further investigation is needed to explore these findings.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD, Boston Scientific.