New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

Abstract Inflatable penile prosthesis (IPP) implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in IPP surgery, we compared surgical outcomes in a retrospective case series of 253 IPP surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, post-operative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned post-operative visits, pain medication refills, and IPP surgery-associated Clavien-Dindo complications. Compared to RFNAs, resident-assisted IPP surgery was associated with significant increase in mean operative time (71.4 min vs 87.9 min, p<0.01) and post-operative ER visits (3.0% vs 10.6%, p=0.03) but not IPP surgery-associated complications (19.7% vs 20.8%, OR 1.03, 95%CI [0.46 -2.30], multivariate regression) or other measured outcomes. Resident participation did not increase IPP-related complications compared to a dedicated RFNA, supporting the notion that resident assistance in these procedures is appropriate and an important part of training.