Ryan P. Terlecki, MD, FACS presented “Avoiding the Problem Patient in Penile Prosthetic Surgery” during the 11th Urology Today Conference on October 28, 2023.
How to cite: Terlecki, Ryan P. “Avoiding the Problem Patient in Penile Prosthetic Surgery” October 28, 2023. Accessed Aug 2024. https://grandroundsinurology.com/avoiding-the-problem-patient-in-penile-prosthetic-surgery/
Avoiding the Problem Patient in Penile Prosthetic Surgery – Summary
Ryan P. Terlecki, MD, FACS, provides physicians with tips for effective communication in prosthetic candidates, recognizing behaviors that might suggest patients have unrealistic expectations, and the best practices for assessing and counseling patients prior to prosthetic surgery.
While urologists familiar with this procedure commonly cite infection and erosion as the most troublesome issues in these patients, Dr. Terlecki argues that patient expectations are the hardest to manage. Oftentimes, patients will exhibit characteristics in the mnemonic CURSED Patient (Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric). Preoperative counseling can help immensely in managing these patients’ expectations. Stressing that the goal of this procedure is not penile lengthening, but rather creating rigidity on demand; the device length is custom-fit to the patient’s anatomy; future lengthening is possible, but not guaranteed; and the truth behind common misconceptions can attribute to patient contentedness.
Planning in all stages of approaching these cases will set up physicians for success, mitigating backlash and pressure to make rash decisions from the patient. Starting with patient selection, it is imperative to judge surgery suitability, health status, relevant history, and body habitus carefully. In addition to these medical considerations, the role of the patient’s partner is a key factor in this decision. Scheduling confirmations on insurance preoperatively; ensuring all products, devices/instruments, and graft materials are available at the time of the surgery; and educating the operating room support staff on specifics in advance can alleviate stressors and complications during the procedure. Confidence in choice of device, surgical approach (penoscrotal vs infrapubic vs subcoronal), and reservoir positioning is also crucial to ensuring optimal outcomes.
About The 11th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 11th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Ryan P. Terlecki, MD, FACS, is a reconstructive urologist for Atrium Health Wake Forest Baptist Medical Center, an academic Level 1 trauma center in Winston-Salem, North Carolina. Dr. Terlecki holds the rank of Professor and the title of Vice Chair of Research for the Department of Urology. In addition, Dr. Terlecki is Director of the Men’s Health Clinic, Director of Medical Student Education, and Fellowship Director for Reconstructive Urology. He holds a joint appointment in the Department of Obstetrics and Gynecology.
Dr. Terlecki earned his medical degree from Wayne State University School of Medicine and completed residency in general surgery and urology at Detroit Medical Center. Following his residency, Dr. Terlecki completed two separate fellowships in reconstructive surgery. He completed a fellowship at the University of Colorado’s Denver School of Medicine and at UT Southwestern Medical Center in Dallas, Texas.
Dr. Terlecki’s publications cover multiple areas of trauma and reconstruction and his research is focused primarily on models of wound healing and regeneration in the lower genitourinary system. Dr. Terlecki’s areas of expertise include urethral stricture disease, male sexual dysfunction, male incontinence, Peyronie’s disease, chronic testicular pain, hypogonadism, and infertility. He is a member of the Society of Genitourinary Reconstructive Surgeons (GURS), a member of the American Urological Association (AUA), and past president of the North Carolina Urological Association (NCUA).
