bluuebunny/crossref_metadata_2025 huggingface dataset:
17 To Drain or Not To Drain an Inflatable Penile Prosthesis Implantation? A Multi-institutional Experience Tracking Scrotal Hematoma and Infection Occurrence
Authors: Osmonov D , Ragheb A , Romero-Otero J , Bettocchi C , van Renterghem K , Jünemann K , Wilson S
Published: April 2022

Introduction

Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection.

Objective

We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration of drainage.

Methods

Our subjects underwent IPP implantation by four European high volume surgeons. All implantations were performed via the penoscrotal access. Only virgin cases were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics according to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days.

Results

There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free.

Conclusions

Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
19 Evaluation of Gram Positive and Gram Negative Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis
Authors: Narasimman M , Chu K , Plano G , Ory J , Bartra S Schesser , Ramasamy R
Published: April 2022

Introduction

Infection is the most feared complication of inflatable penile prosthesis (IPP), often necessitating complete removal. Late infection after IPP insertion is thought to be due to the slow formation of a biofilm. Understanding and preventing biofilm formation would be a breakthrough in preventing IPP infections.

Objective

We aimed to develop an in vitro model to compare formation and growth of biofilms on penile implants by bacteria commonly associated with infection.

Methods

Sterile IPPs (Coloplast Titan) were cut into rings and incubated with S. epidermidis, S. aureus, P. aeruginosa, or K. pneumoniae cultures in tryptic soy broth (TSB) for a 4 h attachment period, and then in only TSB for 120 h. We utilized a published and validated method to measure biofilm mass. Rings were then dipped in deionized water to wash off additional bacteria and either fixed with ethanol (EtOH) or not treated further (no fix). Fixing was employed to preserve biofilm on the rings that otherwise may have been lost during crystal violet staining. Biofilm formation was measured with a spectrophotometer (OD570) after crystal violet staining.

Results

All bacteria formed substantial biofilm on implant rings as measured by OD570. As expected, the gram-negative bacteria, P. aeruginosa and K. pneumoniae produced significantly more biofilm than the gram-positive S. epidermidis and S. aureus. Interestingly, P. aeruginosa formed the most biofilm by at least a factor of 6 in both testing conditions. The ethanol fixing condition produced more consistent results for the crystal violet assay.

Conclusions

Our novel in vitro model of biofilm formation of penile implants can be used in future studies to evaluate the effect of different antibiotic dips and anti-infective capacity of pre-coated implants against different bacteria. Our findings suggest gram-negative bacteria form faster and a greater quantity of biofilm on penile implants as compared to gram-positives. P. aeruginosa displayed the strongest predilection to form biofilm on implants compared to all other bacteria studied, and could be investigated as a specific target to reduce delayed post-operative IPP infections.

Disclosure

Yes, this is sponsored by industry/sponsor: Coloplast

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific
30 Testosterone (T) Recovery Profiles After Short-Term Androgen Deprivation Therapy (ADT)
Authors: Flores Martinez J , Nascimento B , Benfante N , Schofield E , Mulhall JP
Published: April 2022

Introduction

ADT plays a major role in several scenarios for men with prostate cancer. T recovery after ADT cessation may be incomplete with 10% of men estimated to suffer persistent castrate levels after long-term ADT.

Objective

The objective of this study was to evaluate T recovery after short courses of ADT.

Methods

Study population included men treated with ≤6 months of ADT in association with radiation therapy (RT). Early morning T levels were collected at baseline and periodically after ADT cessation. T recovery after ADT cessation was analyzed in 2 ways: improvement to non-castrate level (T ≥50 ng/dL), and recovery to normal (T ≥ 300 ng/dL). Recovery rates and median survival time were estimated using Kaplan-Meier statistics and predictors analyzed using Cox proportional hazard ratios.

Results

88 men with a mean age of 68 ± 8 years at time of ADT were analyzed. Median duration of ADT was 3.1 months; 56% had an ADT duration between 1-3 months and 44% between 4-6 months. Mean pre-ADT T level was 390 ± 158 ng/dL. After cessation of ADT, median time to non- castrate levels was 9.3 (IQR = 6.3 – 18.5) months and 15.8 (IQR = 8.3 - 33.8) ‘months for recovery to T ≥300 ng/dL. Higher baseline T levels (T > 400 ng/dL) was associated with a faster recovery to normal T level (HR = 1.80, 95% CI = 1.09 – 2.95), but not to non-castrate level. Neither age > 65 years, prevalent diabetes, nor ADT duration of 4-6 months vs ≤ 3 months were significantly associated with a slower T recovery.

Conclusions

Most of our patients remained with low T levels one year after the cessation of ADT. Higher baseline T was associated with faster T recovery to normal (T ≥ 300 ng/dL).

Disclosure

No
31 Systematic Evaluation of YouTube Content on Testosterone Therapy: The Proliferation of Bro-Science
Authors: Huang Z , Ruan H , Jeong R , Zhou E , Cohen T , Kim J , Berg W
Published: April 2022

Introduction

There has been a marked increase in commercial advertising and prescriptions for testosterone therapy over the last two decades. Patients are increasingly turning to the internet and social media as their initial source for medical information.

Objective

We sought to investigate the quality of information for testosterone therapy on YouTube.

Methods

A YouTube search was performed using the keyword ‘testosterone therapy’. The top 150 most viewed videos were then assessed for inclusion criteria. Videos were evaluated using the DISCERN consumer health evaluation technique and scored via the Patient Education Materials Assessment Tool (PEMAT) by five reviewers. Videos that exceeded twenty minutes in duration, were non-English, were duplicated, consisted of unrelated content, or were presentations intended for medical professionals only, were excluded.

Results

A total of 88 videos met inclusion criteria with a cumulative total of 14,282,476 views. Median video length was 9 minutes (range 1-20). Sixty-eight percent (n=60) of videos were produced by individual YouTubers with no medical background. Twenty-three percent of videos featured a physician with only 7% featuring a urologist. Median DISCERN quality score was 2 (1-5) with 76% of videos rated as moderate to poor quality (DISCERN ≤3). Videos featuring a physician had better content quality compared to videos that did not (DISCERN 3.5 vs 2, p<0.01). Median PEMAT understandability and actionability scores were 81 (31-100) and 50 (0-100) respectively. Forty-five percent of videos included the YouTubers’ personal experiences of undergoing testosterone therapy. Eight (9%) videos discussed testosterone therapy in females. Forty-three percent of videos discussed side effects of testosterone therapy; however, only 10 % (n=9) mentioned infertility as a negative effect. Seventeen percent (n=15) of videos contained potentially misleading information with a total of 3,537,609 views.

Conclusions

Less than a quarter of the most popular videos on YouTube discussing testosterone therapy featured a physician. Less than half of them discussed side effects of testosterone therapy with only ten percent mentioning infertility. With the increasing role of the internet and social media in patient medical decision making, a stronger physician presence on YouTube and other platforms can help deliver more accurate and accessible information to the public.

Disclosure

No
41 Sexual Activities and Fear-related Reasons for Avoiding Sexual Activities in Early Pregnancy: A Cross-sectional Study
Authors: Phan CT , Tran DC , Hoang BL , Tran KT , Pham TTT , Thi H Dao , Van T Ngo , Viet A Bui
Published: April 2022

Introduction

Several studies have reported women's worry that sexual intercourse may harm the course of pregnancy

Objective

To assess if fears about harming the pregnancy are associated with avoidance of sexual intercourse during pregnancy

Methods

A cross-sectional study was conducted on 250 Vietnamese pregnant women in the first or second trimester who visited our hospital for antenatal care. Sexual function was measured by the Female Sexual Function Index (FSFI) questionnaire. The types of fears that were explored in the study included preterm labor, premature rupture of membranes, bleeding, infection, and fetus harm, and were measured by modified questions from the Reasons For Not Engaging in Sexual Activity During Pregnancy (RFNS) questionnaire. Using the total fear score, pregnant women were categorized into low, moderate, and high fear. Main Outcome Measures: Not having sexual intercourse during the past 4 weeks

Results

Seventy-two (28.8%) pregnant women had no sexual intercourse for the past 4 weeks. All types of fear were common among pregnant women, the more important fears were infection and harming the fetus. On multivariable regression analysis, the prevalence of not having sexual intercourse was higher in both women who had moderate (adjusted prevalence ratio (PR) = 2.84, 95%CI 1.42–5.67) and high fear (adjusted PR = 4.39, 95%CI 2.28–8.44)

Conclusions

Avoidance of sexual intercourse was common among Vietnamese pregnant women and was associated with the fears about harming the pregnancy. This can be a target in the health education programs for pregnancy couples

Disclosure

No
64 Development of a Machine Learning Algorithm for at Home Curvature Assessment
Authors: Witherspoon L , Soltani R , Gleave J , Hach F , Flannigan R
Published: April 2022

Introduction

Peyronie's disease prevalence estimates suggest that 11-15% of men suffer from this disease, although only 1% seek evaluation. When patients do seek help, tools for penile curvature assessment are lacking. This represents a barrier for both patient engagement with a health care provider, and for proper assessment by their treating clinician.

Objective

We set out to develop a tool for patient and clinician led assessment of Peyronie's disease using a neural network system capable of plaque assessment of photographic images.

Methods

Men underdoing penile curvature assessment in a sexual medicine clinic were recruited to enroll in this study. Images were taken of the erect penis from the left, right and top sides using an Apple iPad™. Model training was conducted with a residual neural network (ResNet), a neural network-based framework used for image recognition, to identify male genitals. To assess basic curvature a mathematical formulation was created to calculate the penile curvature after fitting linear lines from genital tip to curvature point and from curvature point to the base of the penis. To validate the algorithms performance two urologic surgeons with extensive experience performing curvature assessments were asked to use the labelling software Rectlabel™ to place linear lines identifying the penile curvature on the same photographs used to train the model.

Results

Initial training of the image analysis model has allowed for identification of the presence of a curvature of a penis, with ongoing training for curvature quantification (Figure 1). We have trained the model to remove background images, isolating the genitals (Figure 1) to aid in patient privacy. When assessing the models ability to measure penile curvature the algorithm calculated the curvature with a median difference of 7.7 degrees between model and physician assessment across the photographic library.

Conclusions

This study presents an algorithm capable of performing accurate curvature assessment based on photographic images. With demonstration of curvature assessment via photographic images this will allow patients to perform an initial curvature assessment at home, improving motivation for patients to seek help. Furthermore, this technology can augment clinician led curvature assessment, providing an objective and easy means for documenting disease severity.

Disclosure

No
65 Standardizing Sonographic Descriptors of Peyronie's Plaques
Authors: Baird B , Haehn D , Broderick G
Published: April 2022

Introduction

Peyronie's Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD.

Objective

The purpose of this study is to establish a functional, reproducible sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status.

Methods

In our study, 395 patients with PD underwent intracavernous injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. CCDU findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea.

Results

There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). Neither median age nor body mass index (BMI) of the cohorts were significantly different: Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Medical risk factors for erectile dysfunction, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery were not statistically different for the three cohorts. Most patients had previously used PDE5-Inhibitors (293/395). History and or physical findings of Dupuytren's palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different in the three cohorts (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2).

Conclusions

The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%); on the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system. This grading system based on grayscale ultrasound of Peyronie's plaques may serve as a paradigm for diagnosis, didactics and integrated research.

Disclosure

No
74 Does Treating a Penile Plaque with Collagenase Clostridium Histolyticum Lead to Changes in Vascular Characteristics?
Authors: Soubra A , Greenberg JW , Kim J , Natale C , Pincus J , Ottaiano N , Nguyen HMT , Almajed W , Sikka S , Hellstrom WJ
Published: April 2022

Introduction

Peyronie's Disease (PD) is a localized disease of the Tunica albuginea (TA) characterized by the formation of fibrotic plaque. Patients with PD present with erectile dysfunction (ED) up to 32% of the time. We have presented in previous studies that the most common etiology of ED in this population is vascular leak characterized by elevated end-diastolic velocity (EDV) on penile duplex doppler ultrasound (PDDU). It is postulated that the change in the architecture of the TA could be the cause of this venous leak; however, this is not definitive. XIAFLEX, which is a collagenase clostridium histolyticum, has been used in clinical practice since 2013 to dissolve the abnormal deposition of collagen type I and III, which is the predominant type in the fibrotic plaque.

Objective

In this study, we explore if there is a change in mean EDV and rate of vascular leak measured on PDDU before and after receiving four cycles of XIAFLEX in patients treated for Peyronie's disease.

Methods

All patients presenting to our institution with chief complaints suggestive of PD undergo PDDU as part of the initial evaluation. Patients who are eligible and choose to get Xiaflex underwent four cycles of treatment, each consisting of two injections 24-72 hours apart. They then undergo another PDDU 8 weeks after completing the last cycle to assess response to treatment. Peak systolic velocity, EDV, resistive index, curve degree, and direction are usually recorded during the test at 0, 5, 10, 15, and 20 min after injection of a vasoactive agent. The lowest value recorded of EDV at times 10, 15 or 20 min at the time of maximal tumescence/rigidity was chosen for the analysis.

Results

We identified 223 patients with PD who underwent XIAFLEX treatment with 148 completing all 4 cycles at our center between 2016 and 2020. All patients had complete data available for analysis. 87% of patients showing improvement of equal to or more than 15 degrees after four cycles of treatment. The mean EDV at the initial PDDU was 26.7, while the mean EDV at the follow-up study was 13.9 (image 1). The rate of the non-vascular PDDU findings increased after XIAFLEX treatment with initial study containing 38% as compared to 48% on follow up (p-value: 0.044).

Conclusions

The mean EDV and the rate of the venous leak seem to decrease with the treatment of XIALFEX for Peyronies disease. Whether this is related to change in the architecture of the plaque or improved erectile function in general due to psychological and various factors in the patient who experience improvement in the curve is to be further explored.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
151 Factors that Drive Patient Satisfaction in Early Recovery Period After Minimally Invasive Surgical Therapy (MIST) for BPH: a Sub-Analysis of PUL and Rezum
Authors: Schiff W. , Tutrone R.
Published: April 2022

Introduction

As utilization of MISTs for the treatment of BPH increases, physicians and patients should seek to understand not only long-term symptom outcomes, but also factors that may drive high satisfaction during the recovery period.

Objective

This new sub-analysis evaluates factors that may influence satisfaction in the early recovery period after undergoing Rezum Water Vapor Therapy (Rezum) or UroLift Prostatic Urethral Lift (PUL).

Methods

Within 2 months post-procedure, 30 PUL and 23 Rezum patients completed a questionnaire detailing their experience. Highly Satisfied patients achieved a pooled score of ≥3 on two questions on the subject of satisfaction (satisfaction with the effect of the procedure on urinary symptoms; satisfaction with speed and ease of recovery). For each question, a score of <0 = dissatisfaction and a score of +2 = high satisfaction. Outcomes were compared between all Highly Satisfied vs. all Dissatisfied patients, and between PUL vs. Rezum patients.

Results

Highly Satisfied patients in the early recovery period after either procedure reported significantly better absolute IPSS (8.0 vs. 24.3, p<0.0001) and QoL (1.0 vs. 4.6, p<0.0001) compared to Dissatisfied patients. Catheter duration was shorter for Highly Satisfied patients (1.9d) compared to Dissatisfied patients (5.6d, p=0.02). Highly Satisfied patients experienced lower rates of interference by their urinary symptoms with activities related to sports, entertainment, and community, and experienced less impact of recovery on work (p-value = 0.002). Within this early recovery timeframe, outcomes associated with increased satisfaction (IPSS, QoL, catheter duration, interference by urinary symptoms with sports, entertainment, and community activities) were better for PUL vs. Rezum patients (respective p-values: 0.001, 0.04, <0.001, 0.007, 0.01, 0.04).

Conclusions

Better absolute IPSS and QoL scores, less interference by urinary symptoms, and shorter duration of catheterization in the early recovery period appear to be factors which correspond to satisfaction in this population of MIST patients; these factors demonstrate superior outcomes for PUL patients compared to Rezum.

Disclosure

No
154 Post-Phalloplasty Urinary Function Test: A Novel Outcome Instrument to Capture Urinary Dysfunction and Quality of Life after Phalloplasty
Authors: Liu J. , Eisenbeis L. , Preston S. , Burnett A. , DiCarlo H. , O'Brien Coon D.
Published: April 2022

Introduction

Due to rapidly growing demand for gender affirmation surgery, the number of phalloplasties performed has increased dramatically. Existing research focuses largely on surgical complications and in transmen there is no widely accepted post phalloplasty specific urinary questionnaire.

Objective

The objective of this study is to present a novel patient-reported outcome instrument – the Post-Phalloplasty Urinary Function Test (PPUFT) – and protocol to measure post-void urethral volume (PVUR) and preliminary results.

Methods

We conducted a cross-sectional pilot study in a cohort of 15 adult transmen who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021 by a single center. Patients had stable urinary function via the neophallus at time of survey. Patients filled out the PPUFT and were asked to record their PVUR as per our protocol.

Results

The average PPUFT score was 8.86 out of 40 and the average quality of life (QOL) score was 2.6. Post void dribbling constituted the major complaint and on average comprised 63% of the reported PPUFT score. Average PVUR was 2.16 ml (range 0.5-5.6 ml). There was a positive correlation between higher PPUFT and worse reported quality of life (p=0.01; R2=0.39).

Conclusions

Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group, especially post-void symptoms from the unique anatomy of a flap-based neo-urethra. The combination of PPUFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty. Future studies will validate these instruments.

Disclosure

No
169 Red Sky in Morning: A Case of Concurrent Hematospermia and Anorgasmia
Authors: Yee A. , Tennenbaum D. , Rabinowitz D. , Khurgin J.
Published: April 2022

Introduction

Hematospermia, or blood in the ejaculate, usually follows a benign course. However, it can be a source of considerable anxiety in patients. Similarly anorgasmia, or the inability to achieve orgasm despite adequate sexual stimulation may cause significant psychological distress. These rare conditions pose unique challenges for diagnosis and treatment and have distinct considerations when they occur together.

Objective

We present a case of concurrent hematospermia and anorgasmia with the diagnostic and treatment procedures for both. We report that simultaneous cystoscopy, electroejaculation (EEJ), transurethral resection of ejaculatory ducts (TURED), and seminal vesiculography is safe and effective as a diagnostic and treatment modality.

Methods

Medical history, physical exam, laboratory analyses of blood, urine, and semen were performed. A cystoscopic video of the prostatic urethra was recorded while performing EEJ, in order to observe hematospermia under direct vision. A TURED was then performed to evaluate the ejaculatory ducts and to facilitate seminal vesiculography.

Results

A healthy 36 year old man reported avoidance of all sexual activity after a few episodes of hematospermia due to extreme fear. He continued to note bloody discharge on occasion in the morning, attributing this to bloody nocturnal emissions. Despite normal erectile function, he adamantly avoided all sexual activity including masturbation. Prior STI workup, cystoscopy, urinalysis, urine and semen cultures were all negative. Prior treatments with finasteride, NSAIDs, and antibiotics failed to reduce the frequency of hematospermia, and he had minimal improvement in libido with cabergoline and buproprion. Concurrent urethroscopy and EEJ revealed initial hematospermia from bilateral ejaculatory ducts with normal, white emission after several seconds. A TURED and direct seminal vesiculography revealed hypoplastic seminal vesicles bilaterally. The patient tolerated the procedure well and had resolution of hematospermia post-operatively. He reports improvement in libido and willingness to attempt sexual activity.

Conclusions

Despite a usually benign clinical course, hematospermia can provoke great anxiety in patients to the point of avoidance of sexual activity. We propose a causal relationship between hematospermia and our patient's sexual dysfunction and anorgasmia, as the patient reports renewed interest in sex after his hematospermia resolved post-operatively. A thorough evaluation to rule out more serious pathology and to address the patient's anxiety included simultaneous cystoscopy, EEJ, TURED, and seminal vesiculography. This was both safe and effective in diagnosis and treatment of concurrent hematospermia and anorgasmia, and is the first video demonstration of simultaneous cystoscopy and EEJ reported in the literature to our knowledge.

Disclosure

No
195 Utility of Novel Mapping Biopsy for Improvement of Extramammary Paget Disease Outcomes: A Case Series
Authors: Zurlo R. , Li R. , Mosiello G. , Spiess P.
Published: April 2022

Introduction

Extramammary Paget's Disease (EMPD) is a rare neoplasm typically found in the genital and perianal region. It typically presents as a pruritic, painful rash and is often mistaken for a fungal infection before biopsy is taken. Staging and biopsy technique have not yet been standardized given the cancer's rarity, leading to a recurrence rate ranging from 21-61% recurrence upon literature review.

Objective

To analyze outcomes of EMPD patients receiving mapping biopsy prior to tumor excision

Methods

Retrospective chart review was conducted of 19 EMPD patients treated with biopsy and/or surgery by co-author at our institution from 2013 to 2021. We extracted patient demographic data, length of follow-up time, percent positive biopsy sites, margin status, recurrence status, and other pertinent disease characteristics.

Results

Within our 19 total patients, median age at diagnosis was 72 with a range between 62 and 88. The majority of patients had a prior history of cancer (13/19), with the most common type being skin cancer (12) followed by prostate cancer (4). No patients were diagnosed with secondary malignancy during mandatory EMPD workup of cystoscopy and colonoscopy before WLE. The majority of patients had not been treated for EMPD prior to presenting to Moffitt (16/19). Of the 16 patients receiving novel mapping biopsy, 8/16 had at least one positive core biopsy site, with a mean of 7% positivity of the total core sites (4/60). Mapping biopsy positive sites helped shape perimeters for wide local excision (WLE) of tumor for patients opting for surgical treatment. Margins of WLE were positive for 11/17 patients. Calculating the length of follow-up time after WLE revealed a median of 6 months, with a range from 0 to 74 months and a mean of 14. No patients received postoperative radiation. One patient did receive topical 5-FU, but use was discontinued after several days due to irritation. Only 1 episode of recurrence was reported during this period of follow-up.

Conclusions

Our novel mapping biopsy technique is an effective way to delineate surgical margins before WLE. Margin positivity is not an accurate indicator of the likelihood of recurrence for EMPD patients, as only 1/17 saw recurrence post-WLE despite 11/17 with positive margins.

Disclosure

No
198 Pre- and Post-injection Pain in Patient's Undergoing First Intracavernosal Injection
Authors: Baird B. , Ericson C. , Broderick G.
Published: April 2022

Introduction

Intracavernosal injections (ICI) are a well-established treatment option with great success rates for men with erectile dysfunction. Unfortunately, the anticipation of pain with injections remains a significant barrier to the use of ICI.

Objective

This study aims to utilize a standardized verbal pain scale to examine the perception of pre- and post-injection pain in men who are undergoing their first injection with an intracavernosal erectile agent. Thus, inclusion criteria required no previous penile injection of any type, including but not limited to erectile medications and collagenase.

Methods

We determined a prospective pre-post observational study would be best to examine men undergoing their first ICI. Men who had no previous history of intracavernosal injection of any kind were asked to predict the pain associated with their first ICI with a score of zero to ten. Patients then received a 10 microgram (mcg) injection of prostaglandin E1 (PGE1). Immediately after they received their injection, they were asked to rate the pain they perceived with the injection on the same scale (0-10). The same physician administered pre- and post-injection scales in a standardized fashion.

Results

A total of 17 of men were asked to rate their pain as discussed in the Methods Section. The average age of men sampled was 61.8 years of age. On review of history, 64.7% of men were found to have used some type of PDE-5 inhibitor before visiting our clinic. The majority of men we saw had erectile dysfunction (70.6%) and/or Peyronie's Disease (58.8%). The average pre-injection prediction pain score was 5.29 +/- 1.90; the average post-injection perceived pain score was 1.21 +/- 0.81. Thus, there was an average decrease of over 4 points in predicted pain versus perceived pain. A two-sample t-test was performed; in addition, a Wilcoxson Signed Rank Test was performed. Both of these tests showed statistical significance in the difference between pre- and post-injection pain scores (p <0.001).

Conclusions

We found that patients who are undergoing ICI for their first time have a significantly higher prediction of pain versus perception of pain after the injection. We have utilized this data in our clinic to explain to patients that while the majority of patients predict high pain scores associated with injection, the vast majority of patients report very minimal pain associated with the injection. Patients can be more open-minded to ICI therapy which could help aid them with their erectile status; this can particularly be helpful in patients who want to avoid surgery and in patients who are not good surgical candidates.

Disclosure

No
203 Successful Treatment of Hard Flaccid Syndrome: A case report
Authors: Nico E , Rubin R , Trosch L
Published: April 2022

Introduction

Hard flaccid syndrome (HFS) is a chronic, painful condition cited in several patient online forums but poorly defined in literature. Gul and Towe were the first to report on cases of HFS with symptoms including a semi-rigid penis in the flaccid state, erectile dysfunction, penile sensory changes of numbness and coldness, and incomplete voiding. These symptoms have a rapid onset, typically following a traumatic event during sexual intercourse or masturbation. The leading hypothesis regarding the pathophysiology of HFS involves physical or psychological stress which injures the pelvic floor neurovasculature leading to prolonged contraction of the pelvic floor muscles and subsequent pelvic floor dysfunction. Though there is no standardized treatment for HFS, patients have been treated, largely unsuccessfully, with analgesics for the neuropathic pain, phosphodiesterase 5 inhibitors for the erectile dysfunction, and pelvic floor relaxation exercises for the overactive pelvic floor muscles.

Objective

We present a case of a patient diagnosed and successfully treated for HFS.

Methods

A 16-year-old male patient presented to the emergency room with penile and testicular pain and numbness after masturbation and other associated HFS symptoms. Laboratory and imaging tests were normal. He underwent a circumcision for phimosis which did not relieve his symptoms. His symptoms persisted for several months until seeking a sexual medicine trained urologist. The patient was referred to pelvic floor physical therapy and through a series of exercises targeting abdominal and gluteal muscles he became symptom free.

Results

We found that specialized pelvic floor physical therapy can relieve the overactive pelvic floor and entrapped penile neurovasculature, supporting and supplementing the leading theory on the pathophysiology of HFS. The patient, like many of the others cited in forums and case reports, also had an inciting traumatic stressor, masturbation, for his HFS. This physical trauma to the pelvic neurovasculature partially explains the contraction of pelvic and penile musculature and resultant erectile and ejaculatory dysfunction; however, it does not provide a full picture of the pathophysiology of HFS. In this case study, physical activity level, social factors, changes in muscle strength and coordination, and postural changes may have all played a role in the development of this chronic condition.

Conclusions

HFS is a rare condition that requires further research. A multidisciplinary approach including individualized pelvic floor physical therapy that addresses impairments beyond the pelvic floor may be a key in treatment.

Disclosure

No
217 Health Care Provider Knowledge and Attitudes about Erectile Dysfunction and Penile Implants
Authors: Roshandel MR , Ziegelmann MJ , Helo S , Köhler TS , Collins CS
Published: April 2022

Introduction

Erectile dysfunction (ED) stems from a variety of etiologies and often requires a multidisciplinary approach to optimize patient care.

Objective

We sought to assess attitudes and confidence regarding the treatment of erectile dysfunction across different provider types.

Methods

Anonymous, email-based survey of physicians and advanced practice providers in the disciplines of urology, internal medicine, and family medicine. Responses were recorded using a five-point Likert scale. Descriptive statistical analysis of survey response data was performed.

Results

With 76 providers on this ongoing survey including 31 internists, 24 family physicians, and 21 urologists, 88% of providers believed there to be good options for erectile dysfunction after failing pills. Figure 1 shows attitudes of the modalities of “good” options and confidence in the ability to counsel about these options. Regarding if most patients report willingness to consider surgical intervention for ED when counseled about it an equal portion of providers had positive, neutral, and negative feedback. Figure 2 lists other specific attitudes and opinions about penile prosthesis (IPP) implants. Moreover, 78% emphasized the necessity of a multidisciplinary team-based approach to ED patients. However, only 30% of the participants were in agreement with referrals to specialists in sexual health including urologists.

Conclusions

This survey indicates a knowledge gap and low comfort level in 2nd and 3rd line ED treatments. Focused education on penile implant outcomes appears particularly helpful.

Disclosure

No
222 Pharmacovigilance Analysis of Reports of Sexual Dysfunction Associated with Finasteride Use: Implications for the Post-Finasteride Syndrome
Authors: Nguyen D , Herzog P , Cone EB , Labban M , Zorn KC , Chughtai B , Basaria S , Elterman DS , Trinh Q , Bhojani N
Published: April 2022

Introduction

Finasteride, a 5α-reductase inhibitor, is used in the management of androgenetic alopecia and benign prostatic hyperplasia (BPH). There is growing attention to the post-finasteride syndrome, a constellation of adverse events associated with finasteride use which include sexual dysfunction.

Objective

To investigate reports of sexual dysfunction associated with finasteride.

Methods

We conducted a pharmacovigilance study using VigiBase, the World Health Organization's international database of individual case safety reports. We used the reporting odds ratio (ROR). Sensitivity analyses stratified by indication (BPH and alopecia) and age (<45 and ≥45); compared finasteride signals to those of drugs with different mechanisms but similar indications (minoxidil for alopecia and tamsulosin for BPH); compared finasteride to a drug with a similar mechanism of action (dutasteride); and compared reports of sexual dysfunction before and after 2012.

Results

We identified 7700 sexual dysfunction reports associated with finasteride. There was a disproportionality signal for sexual dysfunction associated with finasteride (ROR 50.3, 95% confidence interval (CI) 49.0-51.6). Patients under 45 (ROR 56.4, 95% CI 53.1-59.9) and alopecia patients (ROR 64.9, 95% CI 62.7-67.2) drove the signal. All sensitivity analyses met the threshold of signal significance. Results of primary and sensitivity analyses are presented in Tables 1 and 2.

Conclusions

We detected disproportional signals of sexual dysfunction linked with finasteride use. Despite sexual dysfunction being more prevalent in older BPH patients, we detected larger signals of sexual dysfunction in young alopecia patients. Sensitivity analyses suggest that reports of sexual dysfunction linked with finasteride use may be confounded by indication and by stimulated reporting. However, confounding alone is unlikely to account for the totality of the signal observed in young patients with alopecia.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: QDT reports personal fees from Astellas, Bayer, Janssen, Insightec, and Intuitive Surgical, outside the submitted work. NB, DSE, and KCZ reports consulting fees from Procept Robotics, Olympus, and BSC. BC reports consulting fees from BSC, Olympus, Meditate, Ferring, and Urovant.
226 Is Testosterone Really Your Sex Hormone: Sexual practices as Defined by Testosterone Concentration
Authors: Campbell K , Velazquez O , Sullivan J , Lipshultz L
Published: April 2022

Introduction

Testosterone has long been thought of as the male sexual hormone. Individuals with elevated levels of testosterone have been portrayed to have increased sexual promiscuity. It is not unimaginable that these theories would become prevalent at the opposite end of the spectrum and demonstrable with muted sexual practices seen with lower levels of testosterone.

Objective

This study evaluates sexual encounter tendencies of individuals based on testosterone level as well as by race.

Methods

The National Center for Health Statistics (NHANES) was searched from 2011 to 2016 for males over the age of 18 with available serum testosterone levels. All participants were grouped by age and further subdivided by race. Average testosterone values in increments of 100ng/dL were plotted against different age groups per race. The average age of the first sexual encounter and average number of total lifetime female sexual partners were plotted against testosterone per race. Men who self-identified as “homosexual” were not examined due to the limited sample size. Additionally, men with greater than 500 sexual lifetime partners were excluded as not reflective of the general population.

Results

A total of 3,179 participants were identified and evaluated. Average testosterone levels showed a decreasing trend with age below 50-year-olds (<20 = 490.70, 20-29 = 478.78, 30-39 = 407.03, 40-49 = 401.59; p< 0.0001). Substratification revealed an increase in testosterone in men > 50 (423.16, p< 0.0001). Testosterone stratified by race showed no difference (p < 0.0001). The age of first sexual encounters did not change when stratified among testosterone ranges (average = 17.27, p = 0.008353). When substratified by race, Asian men reported their first sexual encounter at an older age (22.03, p = < 0.0001). The average number of total lifetime sexual partners was 14.50 and did not change when stratified among all testosterone values (p< 0.368). Substratification revealed a significant difference only between testosterone levels in the 200-300ng/dl vs 400-500ng/dl (13.00 vs 15.50, p = <0.0001)

Conclusions

The number of lifetime sexual partners and earlier age of sexual activity were not found to have a consistent correlation with testosterone values. When examined by race, Asian men were noted to have their first sexual encounter at an older age.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Abbie, American Medical Systems, Augmenta LLC, Clarus Therapeutics, Endo Pharmaceuticals, Lipocine, Vault Health
230 Boston Scientific vs. Coloplast: A Prospective Analysis of a Single High-volume Surgeon's Inflatable Penile Prosthesis Experience
Authors: Lopez J , Bansal U , Brunner R , Luna E , Khera M , Gheiler E
Published: April 2022

Introduction

Surgical implantation of a penile prosthesis may be offered to patients with erectile dysfunction (ED) as primary treatment or after failed therapy. The two FDA approved three-piece inflatable penile prostheses (IPPs) on the market, the AMS (American Medical Systems) 700TM series (Boston Scientific, Massachusetts) and the Coloplast Titan® (Coloplast, Minnesota), differ in their overall design and anti-microbial coating. However, little is known as to whether these differences have an impact on risk of infection or revision.

Objective

To compare the likelihood of infection and short-term revision in IPP placements performed by a single high-volume surgeon when using Boston Scientific's AMS 700TM series versus Coloplast Titan® implants.

Methods

We performed a prospective analysis of a single IPP surgeon's experience with AMS 700TM and Titan® at two private hospitals between January 2017 and December 2019. The surgeon alternated the implants every other week for comparison. Data was collected on patient demographics, implant characteristics, case duration, and complications.

Results

A total of 542 patients (mean age 69.2 years) underwent 548 IPP implantations during the two-year period. Of the 548 cases, 303 (55.3%) implantations were performed using Boston Scientific AMS 700TM while 245 (44.7%) were with Coloplast Titan®. Only one (0.18%) case was complicated by post-operative infection despite drain placement for three days in all 548 cases. This infection occurred in a Coloplast Titan® placed as a revision for SST deformity. Seven (1.3%) cases ultimately required revision by the time of review. Although five of the seven cases requiring revision were done using AMS 700TM implants, this did not amount to a statistically significant increase in risk compared to Titan® (p=0.39). First revisions of AMS 700TM were noted to be done earlier than Titan® on average (225 days vs. 450 days postoperatively, p=0.42). Overall, the most common reason for revision was tube fracture (n=3). Diabetes, case time, performing hospital, reservoir type, and reservoir location were not significant prognostic factors for revision (p>0.05).

Conclusions

Risk of infection or short-term revision is not impacted by whether the IPP is manufactured by Coloplast or Boston Scientific. A high-volume IPP surgeon has a significantly decreased risk of infection and revision compared to those currently published in the literature.

Disclosure

No
232 Patient Perception of Penile Size and Device after Penile Implant Revision for Mechanical Failure
Authors: Habashy E , Ziegelmann M , Helo S , Trost L , Kohler T
Published: April 2022

Introduction

IPP revision after implant malfunction yields rare insight into patient preference and perception of penile implant variations in brand and size.

Objective

To assess patients’ perception of their penile implant after IPP revision.

Methods

Retrospective review of all patients undergoing revision surgery for purely mechanical malfunction (fluid leak) at our institution since 2017. Patients with greater than 6 months follow-up after revision were contacted to comment on changes in penile size and device preference. Patients were asked 1. “Did you notice any change in penile length or girth after your last surgery, explain, and 2. “Please describe your preference (if any) of implant and why”. We utilize the Coloplast Titan with “classic” (genesis) pump in most cases, with AMS Cx cylinders being used in cases with attenuated corpora (aneurysm).

Results

21 patients were identified that met criteria with an average age of 70. 15/21 were successfully contacted. 9 Coloplast, 2 Mentor, and 12 AMS devices (Cx =7, LGX =4, Ultrex =1) were revised. Device brand used to replace the broken IPP was n= 19 for Coloplast and n=3 for AMS (Cx =2, Lgx =1). Mean and median time to revision was 9 years overall (2-26) and was similar between Coloplast and AMS. Fluid leak location showed no discernable pattern. Total average implant length increased 2.2 cm from 20.6 cm to 22.8 cm. 8/10 patients were reached that had had both AMS and Coloplast devices (all AMS initially). 12 patients stayed within the manufacturer. Despite change in implanted length, most patients did not discern a definitive change in penile length unless cylinders increased by > 3 cm (perhaps reflecting under-sizing of initial implant). All patients correctly described improvement or no change in penile girth when compared to actual cylinder sizes. Patients preferred Coloplast (6 – girth/erection quality/pump), AMS (1 pump/flaccidity) and undecided (1). Several patients felt consistently cycling the device after revision led to relative length improvement and ease of use.

Conclusions

Our small cohort of IPP revision patients for mechanical failure reveals that revision often requires longer cylinders but this is often imperceptible to the patient. Increased cylinder girth was a key factor in driving device preference.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast