(642) From Operating Room to Bedroom: Enhanced Recovery in Penile Implant Surgery

Introduction Enhanced recovery programmes (ERP) have a well-established role in the post operative management of patients following major surgery. They have been demonstrated in other areas of urology to improve patient outcomes, and reduce hospital stay whilst reducing complications and readmission rates [1]. Objective This study was to determine if there may be a role following penile prosthesis surgery. Methods A survey was conducted over a 16-day period in the various clinical areas involved in the patient journey and experience to determine the level of confidence and the homogeneity in patient care. Staff confidence levels were measured on a Likert scale from 0-5 in 3 domains: ward care, admission management and discharge planning. The clinical approaches across 4 critical areas in implant care were also assessed; urine dipstick pre-operatively, drain management, antibiotic prescribing on discharge and catheter management. Results 18 members of the relevant healthcare team completed the survey. 55% of staff reported low confidence (scores 1-2) in ward care confidence. The average confidence scores across ward care, admission management and discharge planning were 2.39, 2.94 and 2.67 respectively. 61% of respondents believed urinalysis was always required on admission, while 11% believed it was never required. The criteria for drain removal demonstrated a greatest variation with 50% removing the drain if <50mls/24hrs, 33% <100mls/24hrs; 11% removed it on day 3 regardless of the output. Antibiotics were prescribed for at least 3 days in 50%. However, 33.3% only prescribed antibiotics if there was a positive urine culture and 16.7% did not prescribe any antibiotics. Our respondents believed that the catheter should be removed at 2 weeks, day 1, based on drain output and in recovery in 38.9%, 27.8%, 22.2% and 11.1% respectively. Conclusions Current literature on enhanced recovery in penile implant has focused on techniques to enhance penile length and girth as well as reducing opiate use post-operatively. This study has established the importance of educating our nursing and junior colleagues who will be managing these patients during their ward admission. The prolonged use of drain and catheters, and the under-utility of post-operatively antibiotics may adversely affect patient experience or increase infection risk. We demonstrate the need for a multidisciplinary enhanced recovery programme for patients undergoing penile implant surgery. References [1] Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD, Pruthi RS, Thalmann GN, Desai M. Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs. Eur Urol. 2016 Jul;70(1):176-187. doi:10.1016/j.eururo.2016.02.051. Epub 2016 Mar 9. PMID: 26970912; PMCID: PMC5514421 Disclosure No