For ten years, Dr. Paul Perito has spent most of his time restoring male sexual ability. He's a urological surgeon who's performed over 3,000 penile implants, and he's even developed his own signature method - The Perito Technique. By dissecting less of the fragile penile tissue than other doctors, he completes the operation in less time and his patients return to their love-life earlier.

Planning, planning, planning

The goal of any surgical training tour is increased awareness. Dr. Perito had a lot of support from the manufacturer's (Coloplast) Australian representatives, who wanted to raise Coloplast's profile for Prosthetic Urology, in their country. The tour would introduce the latest technological enhancement, the Coloplast Titan® "One Touch Release" (OTR) deflation mechanism in the pump, to key Australian surgeons. Dr. Perito would teach Aussie surgeons "The Perito Technique" and lend assistance for any complex cases. The end goal was to raise awareness about Dr. Perito's alternative surgical approach.

Preparations began in November '08, almost five months before the tour. Australia required Dr. Perito to register with each state medical board, have local indemnity insurance, and be accredited at each hospital he'd ultimately operate in. This meant 13 elaborate applications, with different requirements for each, including health checks, police checks, a birth certificate, a high school diploma, etc. All the documents needed to be notarized, and some even needed to arrive in specially-sealed envelopes direct from Dr. Perito's local, Florida medical board. Dr. Perito's own staff was involved with each application, sending "daily" FedEx packs from Miami to Sydney.

As some of the Australian surgeons heard of the planned visit, the Coloplast Australia team needed to "juggle" the itinerary and added sites, surgeries and eventually planned several evening forums for General Practitioners, in each state. Even within a few weeks of the April '09 tour, additional meetings and presentations were requested, until nearly every waking hour included some aspect of surgical training and education.

Day one

The tour began with a 7 a.m. surgery in Sydney. Dr. Perito performed four more implant surgeries and trained five doctors, while moving between three hospitals to meet the tight schedule. After the cases, there was a Urology Forum for General Practitioners near one of the University centers and the team met a huge hurdle!

"As we neared the city centre, a set of traffic lights were out," Dr. Perito said. "We pushed through, only to find another.and another." For the first time in decades, downtown Sydney experienced a complete blackout! The streets were gridlocked and there were 40 Australian General Practitioner physicians in an auditorium across town, hoping to hear from this American specialist.

"We got caught right in the middle," Dr. Perito said. "Police were yelling to all the drivers, to get out of the city." It wasn't pretty. The team eventually got to the University of Sydney, the location of the evening's forum. Given the blackout, attendance was still enormous and Dr. Perito's was well received.

During the first day, Dr. Perito had the opportunity to field questions from the Australian surgeons about technique and his perception of the advantages of the Coloplast Titan system (over the leading competitor) and his clinical experience to back it up.

After a morning flight to Melbourne, the team had a brief meeting with the state medical board, where Dr. Perito signed final registration documents. At the next hospital, seven surgeons were trained and three Titan prostheses were implanted. Each of the seven surgeons had a chance to actively implant with Dr. Perito, during at least one case. All of the surgeons mentioned that they were able to learn from the program and seemed delighted to take-away at least one surgical "pearl" from the visiting Professor.

Dr. Perito worked with the Melbourne surgeons to hold another evening forum and help educate some of the GP's about ED as a disease. The forum was a nice opportunity to hear about treatment alternatives and especially, for patients who have tried Viagra®, Cialis® or a vacuum or injection therapy without success - why the penile implant may be an appropriate option.

Day three

A similar day of travel and training started with a long flight to Perth and was followed by another meeting with another state medical board. While it may seem like a lot of "red tape" Dr. Perito was thankful for the opportunity to work with so many gifted, Australian surgeons and the additional paperwork was a small hurdle in an otherwise smooth week of training. Perth is on the very West Coast of Australia and somewhat remote, so there may not have been as many opportunities for ED Specialists to speak to the medical community. Dr. Perito's evening conference was the best-attended and most enthusiastic forum of the entire tour.

"General practitioners are the gatekeepers of patients" Dr. Perito said. "Patients require a referral from their practitioner to see a surgeon, and practitioners aren't traditionally familiar with treatment alternatives, such as the penile implant. The questions from this group were amazing and having a local Sexual Therapist (Raelene Stokes) and local Urologist (Jeff Thavaseelan) as presenters for this program really worked out well."

Day five

After training with surgeons in Perth and a six-hour flight back to Sydney, the day started with another 7 a.m. procedure in Sydney. This case provided some hurdles, as it was a replacement of a failed previous prosthesis. These cases are not uncommon in Dr. Perito's busy practice in Miami, however they are less common in Australia. It was helpful for the surgeon to have Dr. Perito present and the two specialists considered the best approach to resolving the patient's dilemma.

The "redo" cases occur even with the implant technology continuing to be refined, as the prosthesis is a mechanical/hydraulic device and over time, can wear out. Clinical data shows that approximately 90-95% of the devices are still functional at 10-years. However, the occasional replacement is necessary and it is important to see a specialist, such as Dr. Perito, when that occurs.

Directly after the first case, Dr. Perito was delivered to Sydney Airport for a quick flight to Canberra. Dr. Perito trained a young, active surgeon who has a large ED practice. The surgeon is passionate about becoming a "guru" in the field and was interested in the latest implant technology. The two surgeons implanted three Titan OTR prostheses and over the course of an afternoon, were able to train the entire nursing staff about the handling and steps of the procedure.

"It was really great to watch the Canberra team learn so quickly!" Dr. Perito stated, "The last surgery took less than 20 minutes, as they methodically reduced the number of surgical steps and realized how to work as a team." For many surgeons, the implant procedure may take over one-hour, yet Dr. Perito's technique emphasizes the importance of reducing steps and motion in the OR. "It is NOT about speed," Perito emphasized, "But rather conservation of motion. And the outcome of that reduction is a faster, more fluid procedure." Clinical data suggests that the longer a patient is undergoing any procedure, the greater potential risk for infection and Dr. Perito believes that his clinical success and positive patient outcomes are a direct reflection of the limited steps and trauma during his standard procedure.

A successful tour

Five days, four cities, 16 trained surgeons, 14 implants, 7,218 kilometers - all combined for a positive trip. Dr. Perito would like to thank the many surgical teams throughout Australia for their gracious hospitality and all the constant education that they provided during his tour. It was a lot of work for all of the institutions, but a valuable, productive week.

In follow-up, many of the Australian surgeons whom Dr. Perito trained have since adopted The Perito Technique and commonly use the Coloplast Titan. Dr. Perito continues to provide surgical workshops and training forums at Coral Gables Hospital in Miami, Florida.