Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Scientific Session V: ED/Infertility 46 Inflatable Penile Prosthesis Patients Treated with Multimodal Analgesia Have Reduced Risk of Prolonged Opioid Dependence Rutul D. Patel, MBS 1 , Avery E. Braun, MD 2 , Architha Sudhakar, MD 2 , Jacob W. Lucas, MD 2 , Martin S. Gross, MD 3 , Jay Simhan, MD 2 1 New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA; 2 Einstein Healthcare Network, Philadelphia, PA, USA, 3 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction: The utilization of multimodal analgesia (MMA) in inflatable penile prosthesis (IPP) surgery has demonstrated durable results in reducing opioid usage and improving pain control in the postoperative period. Rates of opioid dependence following opioid-based (OB) or MMApain management in penile implant recipients has yet to be defined. We assessed the risk of prolonged narcotic usage following IPP surgery by comparing prior opioid- based management patients with multimodal analgesia patients. Materials & Methods: This is a multicenter retrospective review of 344 three-piece IPP recipients who underwent implantation from 12/2014 to 12/2020. A total of 133 patients (38.7%) were managed with an OB regimen while 211 patients (61.4.0%) received MMA. Development of prolonged opioid dependence was defined as active opioid prescriptions 90 days after surgery. Perioperative and postoperative opioid usage was assessed with the Prescription Drug Monitoring Program (PDMP). Patients were excluded if PDMP data was incomplete or if preexisting history of opioid dependence was identified. Results: Postoperative inpatient narcotic use was higher in the OB group, with substantially more total morphine equivalents (TME) used (41.3 vs. 13.8, p<0.001). After discharge, the OB group required greater narcotic refills (31.5% vs. 9.8%, p<0.001) and higher total refill TME (276.0 vs. 22.3, p<0.001). IPP recipients managed with MMAhad an absolute risk reduction of 3.6% in developing opioid dependence (ARR=0.036). More OB patients developed opioid dependence with more recipients (6/133, 4.5%) developing opioid dependence despite smaller OB cohort size. All 6 OB patients with prolonged opioid dependence were primary IPPs. MMA patients who developed prolonged opioid dependence were predominantly complex revision cases (p=0.045). The OB andMMAgroups demonstrated similar ages, incidence of chronic pain, and diabetes but differed in BMI (32.0 vs. 30.6, p=0.045) and race (p=0.001). Intraoperative factors did not demonstrate statistical significance. Conclusions: Our series demonstrates that multimodal analgesia recipients have a decreased risk of prolonged narcotics dependence compared to patients managed with opioids alone, particularly after primary IPPs. Substantial differences in opioid use were noted postoperatively between the cohorts, withMMApatients requiring fewer inpatient TMEs and fewer narcotic refills postoperatively. Virtual Learning with Remote Proctoring for Inflatable Penile Prosthesis (IPP) Training: A Feasibility Study for Socially Distanced Education Ahmed Ghazi, MD 1 , Michael W. Witthaus, MD 1 , Molly E. Reissmann, MD 2 , Patrick Saba, BA 3 , Rachel Melnyk, BS, MS 3 , Ricardo Munarriz, MD 2 1 University of Rochester Medical Center, Rochester, NY, USA; 2 Boston University Medical Center, Boston, MA, USA; 3 Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA Introduction: COVID-19 has changed the educational landscape precluding in-person surgical training opportunities. Our objective is to examine the utility and feasibility of remote proctoring for IPP surgical skills training using a validated full-procedural hydrogel simulation model. Materials &Methods: Nine urology residents at the University of Rochester (PGY 1-4) were paired and remotely proctored by an expert at Boston University using the Zoom web conferencing tool. During IPP training sessions, both participants and proctor were given amodel with a full surgical setup. Pre-learning included a narrated full-procedural demonstration by the proctor followed by a full procedure IPP simulation guided by proctor feedback. Pre- and post-training surveys assessed confidence (0-100) and procedural knowledge (15 questions). Opinions on virtual learning and its application to this training session were collected. Results: 66.7% of residents never performed a live IPP placement, while the remaining completed a median (IQR) of 6 cases (4.5-8). All confidence and knowledgemeasures significantly increased after the remote session ( Table 1 ). Knowledge assessment scores increased by 13% following the remote session, which was reflected in an increase in participants’ confidence in the ability to perform a simulated IPP procedure, knowledge of IPP procedural steps, and applied anatomy by 48%, 22%, and 18%, respectively. Despite 77.8% (7/9) of residents having no prior experience with hands-on virtual training, 100% found remote training valuable and beneficial for learning basic IPP skills and steps of the procedure. The residents highly rated the ability to practice complex skills with zero-patient harm (88.9%), the non-biohazardous nature of the model (66.7%), and having their own hydrogel training model (88.9%). 66.7%preferred a hybrid (virtual combinedwith in-person learning) for future sessions. The limitations include single session, lower quality communication, and lack of an interface for physical guidance within the virtual environment. Conclusions: Remote proctoring using a web conferencing tool and non- biohazardous IPP simulation model is feasible with improvement in both confidence and procedural knowledge. Despite its limitations, this approach provides essential opportunities for hands-on training with remote experts in a safe environment during the cessation of in-person training events. Table 1 : Confidence and knowledge measures pre-training versus post-training. 45 24