bluuebunny/crossref_metadata_2025 huggingface dataset:
Two sides of the same leader: an agent-based model to analyze the effect of ambivalent opinion leaders in social networks
Authors: Röchert Daniel , Cargnino Manuel , Neubaum German
Published: April 2022

Opinion leaders (OLs) are becoming increasingly relevant on social networking sites as their visibility can help to shape their followers’ attitudes toward a variety of issues. While earlier research provided initial evidence on the effect of OLs using agent-based modeling, it remains unclear how OLs affect their network environment and, therefore, the opinion climate when: (a) they publicly hold ambivalent attitudes, and (b) they not only express support for their own stance but also discredit or ‘debunk’ the opposing side. This paper presents an agent-based model that determines the influence of OLs in social networks in relation to ambivalence and discreditation. The model draws on theoretical foundations of OLs as well as attitudinal ambivalence and was implemented using two network topologies. Results indicate that OLs have significant influence on the opinion climate and that an unequal number of OLs of different opinion camps lead to an imbalance in the opinion climate only in certain situations. Furthermore, OLs can dominate the opinion climate and turn their stance into a majority opinion more effectively when discrediting the opposing side. Ambivalent OLs, on the other hand, can contribute to greater balance in the opinion climate. These findings provide a more nuanced analysis of OLs in social networks by pointing to potential amplifications as well as boundaries of their influence. Implications are discussed with a focus on human and artificial key actors in online networks and their efficacy therein.
21 Ectopic Reservoir Placement Following Robotic Prostatectomy: Is it Necessary?
Authors: Denison C , Westerman ME , Mutter M
Published: April 2022

Introduction

Traditional robotic-assisted radical prostatectomy (RARP) disrupts the space of retzius (SoR) and may result in small bowel injury with traditional SoR reservoir placement during 3-piece penile prosthesis placement. Given this, ectopic reservoir placement is a widely accepted practice in patients who have undergone prior non-retzius sparing robotic-assisted radical prostatectomy, despite potential for herniation and palpability of the reservoir.

Objective

Reservoir placement in the traditional space of retzius (SoR) is generally avoided in post RARP patients due to concern of bowel injury. Our aim is to evaluate the incidence of incidental small bowel found in the space of retzius after RARP utilizing post surgical imaging. Secondarily, we aimed to evaluate the proximity of small bowel to the pubis in this population.

Methods

434 men who underwent RARP in our department between 01/2012 and 09/2020 were eligible for inclusion. We identified 162 men with cross sectional imaging available after RARP. For men with multiple scans, the most recent was used. Of these, men whose imaging was within one month of surgery or who had complicating factors such as post-operative drains were excluded (n=42). The primary endpoint was identification of bowel posterior to the midline of the pubic symphysis (figure 1). In cases without bowel found in the SoR, distance from the superior aspect of the pubis to the closest bowel loop was recorded (figure 2). Measurements were taken in either the sagittal or axial dimensions. Patient demographic and surgical features were evaluated to determine if there was an association among patients with bowel found in the SoR.

Results

120 men were eligible for inclusion. The mean time from RARP to imaging was 19.4 months. In total, 8/120 (6.6%) men had intra-abdominal contents within the SoR. For men without bowel in the SoR, the mean distance from bowel to the superior aspect of the pubis was 3.81cm. The most common finding among majority of patients (7/8) with bowel found in SoR was a decompressed urinary bladder at the time of imaging.

Conclusions

Based on our observations, penile prosthesis reservoir placement in the SoR can be safely performed, with respect to potential bowel injury in the majority of patients who have undergone prior non-retzius sparing RARP. Cross sectional imaging may be obtained prior to implantation to evaluate for the presence of bowel within the SoR and to guide reservoir placement. Further research evaluating the location of bowel pre- and post-RARP as well as whether this is static or changeable is ongoing.

Disclosure

No
26 Testosterone (T) Challenge in Men Post-Radical Prostatectomy (RP) with Profoundly Low Testosterone
Authors: Flores Martinez J , Mulhall JP , Deveci S , Matsushita K , Torremade J , Salter CA
Published: April 2022

Introduction

Prostate specific antigen is the primary marker of prostate cancer recurrence. PSA secretion is T dependent with T levels below saturation point associated with sub-optimal PSA production. Men with an undetectable PSA level after RP with very low T levels might have an artificially low PSA level.

Objective

We aimed to evaluate the effects of raising T level in such men.

Methods

Study population consisted of (i) men post-RP (ii) with undetectable PSA level (iii) total T levels <200 ng/dl (two levels, LCMS) who (iv) underwent in-office intramuscular injection of 100mg of T cypionate (v) had a PSA level checked 5 days later, and if undetectable every month after that, 3 months later then every 6 months and (vi) follow-up of at least 24 months on T therapy.

Results

22 men have been challenged thus far. Mean age 62±18 years. Mean preoperative PSA 6.2. Mean post-RP TT value 140± 35 ng/dL 2.2. Median Gleason sum 7. 23% had GS ≥8. Mean post-RP, pre-challenge T value 140± 35 ng/dL. Mean time post-RP to challenge was 7± 9 months. Mean TT value 5 days after IMT challenge 640± 220 ng/dL, all with TT levels above 400. 5/22 has a PSA elevation, 2 immediately after IMT challenge (PSA values 0.07, 0.08). All other men started T therapy immediately and had PSA elevation at 9, 14 and 22 months after commencing T therapy (PSA values 0.08, 0.12, 0.11). All patients with PSA elevation had continued rise in PSA and had detectable disease on imaging. All men with PSA recurrence had either GS 7 with unfavorable pathology (2) or GS ≥8 (3).

Conclusions

This T challenge approach permits the early detection of prostate cancer recurrence permitting early intervention. About 10% of such men had a PSA rise immediately after T challenge.

Disclosure

No
36 The Impact of Social Determinants of Health on Female Sexual Function
Authors: Davila J , Tellechea L , Zuo S , Leegant A , Fazzari M , Abraham N
Published: April 2022

Introduction

Social Determinants of Health (SDOH) like economic stability, education, neighborhood & environment, and social and community context, may significantly impact overall health and drive health disparities.

Objective

Our aim was to evaluate the association between female sexual function and SDOH.

Methods

We conducted a cross-sectional study of women 18 and older presenting to outpatient female pelvic medicine and reconstructive surgery (FPMRS) clinics at Montefiore Medical Center (Bronx, NY) from November 2018 to November 2019. The Female Sexual Function Index (FSFI-6) was administered to screen for female sexual dysfunction (FSD) and The Accountable Health Communities Health-Related Social Needs Screening Tool to evaluate unmet social needs. Ordinal logistic regression models were used to examine the association between FSD (defined as FSFI-6 score 19 or less for FSD and FSFI-6 >20 as no FSD) and each social need item, while adjusting for potential confounders.

Results

89 women were included in the analysis, with mean age 55.7 years (SD=13.5) and mean BMI 32 (SD=8.4). 4.5% were White, 38.2% Black, 48.3% Hispanic, and 9% did not identify a race or ethnicity. FSD was associated with women who spoke a language other than English or wanted more schooling/training, whereas women who were searching for employment were less likely to have FSD. However, needing family or community support for completion of their activities of daily living (AOR=4.27, 95% CI:(1.05, 17.38), p = .04) was the only social need statistically significantly associated with FSD after adjusting for age, race, BMI, parity and previous pelvic surgery in ordinal logistic regression analysis.

Conclusions

Family or community support is a social need that was associated with FSD in our diverse, urban cohort. Further exploration with patient interviews may reveal social and cultural beliefs that explain this association. Urologists should consider screening for SDOH to better serve patients with FSD.

Disclosure

No
39 Onset of Flibanserin Treatment Effect in Postmenopausal Women Assessed by Subdomain Scores of the Female Sexual Function Index (FSFI)
Authors: Simon J , Shapiro M , Larkin L , Kim N , Patel S , Kingsberg S
Published: April 2022

Introduction

Flibanserin, a treatment for acquired, generalized hypoactive sexual desire disorder (HSDD), is approved in the US for use in certain premenopausal women and in Canada for use in both premenopausal and naturally postmenopausal women ≤60 years of age. Improvement in symptoms following initiation of flibanserin may take several weeks to emerge and it is important to set realistic expectations of treatment onset.

Objective

The primary objective of this analysis was to evaluate the onset of flibanserin's treatment effect in naturally postmenopausal women with HSDD across the 6 subdomains of the FSFI.

Methods

A post-hoc analysis was conducted using FSFI data from a randomized, controlled, double-blind trial of flibanserin in naturally postmenopausal women with HSDD that included 895 postmenopausal women (flibanserin, n=432; placebo, n=463) who had at least one on-treatment efficacy assessment. The FSFI is a validated, 19-item self-report questionnaire comprising 6 subdomains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain. Each subdomain has a maximum score of 6 and higher scores indicate better sexual functioning. For each subdomain, change from baseline at each assessment visit (4, 8, 16, and 24 weeks) was calculated as the least squares mean difference. Comparisons between flibanserin and placebo groups were performed using analysis of covariance.

Results

Postmenopausal patients treated with flibanserin had significantly greater sexual desire and arousal scores than those treated with placebo at Week 4 and at every assessment timepoint thereafter (see figure). By Week 8, patients in the flibanserin group had significantly higher scores for all FSFI subdomains compared to the placebo group. This treatment effect was maintained at Week 24 for all subdomains except for pain.

Conclusions

Results from this post-hoc analysis indicates that postmenopausal women treated with flibanserin experienced improved sexual function compared to those treated with placebo with regard to sexual desire, arousal, lubrication, orgasm and satisfaction. This improvement was maintained over the entire course of treatment. These findings are consistent with those from a previous FSFI post-hoc analysis of clinical trial data from premenopausal women and suggest that flibanserin treatment of postmenopausal women was associated with improvement of multiple aspects of sexual function in addition to sexual desire.

Disclosure

Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals, Inc.

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals, Inc.
40 Female Genitalia in Pornography: The Source of Labiaplasty Trends?
Authors: Dubinskaya A , Dallas K , Eilber K , Scott V , Anger J
Published: April 2022

Introduction

Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 39% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals.

Objective

The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty.

Methods

After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category “most viewed videos” on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus.

Results

We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora and were consistent with labiaplasty. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted.

Conclusions

We found that the most popular pornography videos had a range of genital appearances, disproving our hypothesis that labiaplasty and bleaching are commonly seen in pornography. However, pornography likely has influenced trends in hair removal. The most viewed videos on the most popular pornography sites may nonetheless create expectations for both genders on the genital appearance of a partner.

Disclosure

No
66 Novel 3D MRI Fusion Penile Imaging Modality for Peyronie's Disease: A Pilot Study
Authors: Pincus J , Lerner M , Sanekommu G , Ottaiano N , Raheem O
Published: April 2022

Introduction

Penile imaging for Peyronie's disease (PD) can be challenging. Traditional cross-sectional imaging modalities such as computerized tomography (CT) or magnetic resonance imaging (MRI) can delineate and characterize pathological penile anomalies; however, limitation in imaging interpretations do exist. Optimal imaging of the penis aids in surgical planning and patient counseling.

Objective

In this study, we aim to utilize a novel three-dimensional (3D) MRI fusion penile imaging modality for men undergoing surgical reconstruction for PD.

Methods

Men with PD, palpable plaques, and deformed corpora were included in this study. We obtained preoperative cross-sectional MRI penile images and Sexual Health Inventory for Men Questionnaire (SHIM) scores on all included patients. We fused MRI images with Ceevra (Ceevra, Inc., San Francisco, CA, USA) 3D imaging software to develop detailed imaging aiding surgical reconstruction. 3D models were used for preoperative patient counseling and surgical planning as well as intraoperatively.

Results

A total of six patients were included, 3 African American men and 3 White men. The mean age was 65 and mean BMI was 35. There was no difference in preoperative SHIM scores (4 severe and 2 mild erectile dysfunction). Preoperative MRI images were fused with Ceevra software to develop detailed 3D models of corporal plaques and its related structures. The 3D models were easily accessible to surgeons during preoperative clinic visits and at time of reconstruction (Figure 1).

Conclusions

In this study, 3D MRI fusion penile imaging for PD has emerged as a potential preoperative advanced imaging modality useful for preoperative counseling and planning, especially in complex PD cases. Further evaluation is prerequisite to evaluate its potential role in aiding intraoperative decision making.

Disclosure

No
67 Postoperative Progress of Modified Grid Incision and Sealing with Collagen Fleece for Treatment of Peyronie's Disease
Authors: Ahn S , Moon DG , Cho S , Lee H , Han DE , Lee DH
Published: April 2022

Introduction

Recently, there have been reports on partial plaque excision and grafting with collagen fleece technique regarding long term efficacy. However, there is still concern regarding complete regeneration of tunical defect from collagen fleece graft in terms of regenerative medicine. Previously, we introduced a less invasive modified technique by multiple grid incisions of Peyronie's plaque to minimize weakness of regenerated tunica from the collagen fleece graft and consequent veno-occlusive erectile dysfunction.

Objective

To assess the efficacy of Modified Grid Incision of plaque and sealing with Collagen Fleece through post-operative progress of 31 patients with prospective follow-up study.

Methods

From Aug 2018, 31 patients with stable Peyronie's disease (PD) were included. Surgical technique was composed 3 major steps; 1) dissection of the neurovascular bundle or urethra according to the location of plaque, 2) multiple deep grid plaque incisions for complete correction of curvature and deformity and 3) sealing with collagen fleece (TachoSil®) without suturing. Prospectively, we assessed the stretched penile length (SPL), totally straightness, penile sono, erectile function preoperatively and 6, 12, 24, 36 months postoperatively. This study was approved by the Institutional Review Board of the Korea University Hospital.

Results

Mean patient age was 58.5 years (range: 46–75). The mean curvature was 45.95 (15-90) degrees, 8 with hinge and 7with hourglass deformity. Inflatable penile prosthesis (IPP) was inserted in 4 patients and postoperative 30 months in a patient for poor erectile function. Mean follow-up was 15 months (6-36). Daily massage softened the hard thickening of penis gradually from 3 months until 2 year. On follow-up sonography, subcutaneous thickening gradually decreased to near normal at 1 year and the breakage of tunica by grid incision reunited at postoperative 10-12 months. All patients achieved totally straightness. All patients gained preoperative length after 1.6 year. 96% of patients satisfied in GAQ at 1 year. Minor skin problem was occurred in three patients of IPP. Subcutaneous bulging hematoma was occurred in 2 patients but subsided within 3 months. In postoperative erectile function of 27 patients without IPP, spontaneous hard erection was recovered in 10 and the rest are satisfied with PED5 inhibitors.

Conclusions

Our prospective progress reports with technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of tunica albuginea. Precise understanding of the postoperative progressions are necessary for physician's confidence and encouraging the patients for successful clinical outcomes.

Disclosure

No
69 Xiaflex® Treatment for Peyronie's Disease May Improve Penile Curvature Degree With No Effect on the Loss on Penile Length in Post-marketing Analysis
Authors: Greenberg JW , Soubra A , Kim J , Pincus J , Ottaiano N , Natale C , Nguyen HMT , Tannenbaum J , Sandberg ML , Almajed W , Sikka S , Hellstrom WJ
Published: April 2022

Introduction

One of the main complaints of patients with Peyronie's Disease (PD), besides the curvature, is penile shrinkage. Both deformities result in significant distress to the patient and his partner. XIAFLEX has been developed to treat Peyronie's plaques with substantial improvement of the curvature in the IMPRESS TRIAL.

Objective

In this study, we perform a post-marketing analysis to see if there is any significant improvement of stretched penile length, erect penile length and erect circumference in patients who respond to XIAFLEX compared to patients who do not.

Methods

Consecutive patients treated with XIAFLEX for dorsal plaque and penile curvature above 30 degrees in the absence of hourglass deformity were included in this study. Penile curvature was assessed using a goniometer after induction of artificial erection using alprostadil, before treatment, and eight weeks after the end of the 4th cycle. Stretched and erectile length, as well as erectile circumference, were measured at the same setting. Based on the results of the IMPRESS trial, we decided that any improvement over 15 degrees was deemed a positive response (given our initial measurements were in increments of 5 degrees).

Results

148 patients with PD and penile curvature above 30 degrees elected and completed 4 cycles of non-surgical intervention were included in this study. In this cohort, 129 (87%) of patients had improvement over 15 degrees after completing eight total injections of Xiaflex. The average penile curvature at the beginning of the study was 61.4 degrees, while stretched penile, erected penile length, and erected circumference were 13.9 cm, 13.3 cm, and 11.8 cm respectively. The figure shows no significant change in neither the erect nor the stretched penile length in patients who responded to the injections. However, there was a significant decrease in the erect circumference in the majority of patients from an average of 11.8cm to 9.3cm.

Conclusions

There appears to be no significant regain of the penile length in which patients often complain about losing due to Peyronie's disease in those who respond to Xiaflex injections. The study finding suggests that the erect circumference might decrease, not necessarily due to the injection itself but due to the disease or recovery process.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
89 Are There Differences in Stretched Flaccid Penile Length Versus Erectile Penile Length in Men with Erectile Dysfunction?
Authors: Flores Martinez J , Salter CA , Benfante N , Schofield E , Mulhall JP
Published: April 2022

Introduction

Penile length measurement is an important tool in various clinical scenarios in andrology. It has been suggested that stretched flaccid penile length (SFPL) is an excellent surrogate for erect penile length (EPL).

Objective

We aimed to evaluate if the SFPL accurately reflects EPL.

Methods

Men with (i) Erectile Dysfunction (ED) without penile curvature (ii) undergoing penile duplex doppler ultrasound (DDUS) (iii) with a rigid erection were analyzed. SFPL and EPL were measured dorsally from the pubic symphysis to the coronal sulcus. Significant discrepancy was defined as a difference ≥1cm between the two measurements. We collected demographic and comorbidity data.

Results

64 men were analyzed with a mean age of 59.4 ± 13.4 years. 37.5% of the patients reported 2 or more comorbidities, 11% had diabetes, 19% obstructive sleep apnea, 29% were current or former smokers, 54% had radical pelvic surgery, and 44% pelvic radiation. Mean SFPL was 10.8 ± 1.9 cm and mean EPL was 11.8 ± 1.8 cm, (p<0.001). 83% had EPL>SFPL. 47% of men had a significant discrepancy between the two measurements. No predictors of discrepancy were identified.

Conclusions

In our cohort of men with ED assessed during DDUS, there was a statistically significant difference between SFPL and EPL measurements. In almost half of the cases EPL was significantly longer than SFPL. SFPL is not a reasonable surrogate for erect penile length

Disclosure

No
90 A Comparison of the Psychosocial Impact of Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction Using the Self-Esteem and Relationship (SEAR) Questionnaire
Authors: Tidwell T , Andrew Salib A , Berry K , Chung P
Published: April 2022

Introduction

The few studies that do compare penile prostheses (PP) and intracavernosal injections (ICI) focus predominantly on sexual function leaving self-esteem and relationships understudied. The Self-Esteem and Relationship (SEAR) questionnaire was developed to provide a reliable tool to assess psychosocial variables of ED treatments. We hypothesized that patients with PP would have higher SEAR scores compared to patients treated with ICI.

Objective

To compare psychosocial variables of PP and ICI treatments using the SEAR questionnaire.

Methods

IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. SEAR questionnaire results were calculated according to the previously described formula and individual questions and domains were compared using T-test statistics.

Results

Fifty patients (25 PP, 25 ICI) agreed to be interviewed for this study. Prostate cancer (n=21, 45%) and vascular disease (n=7, 14%) were the leading cause of ED in our cohort. PI patients on average suffered from ED for a longer period than patients on ICI (5.6 vs 2.7 years, p=0.005). There were no differences in age or marital status. PP patients reported numerically higher total SEAR scores than PP patients (63 vs 53, p=0.12). PI patients reported higher sexual relationships domain scores than ICI patients (64 vs 46, p=0.04), especially in “I felt confident that during sex my erection would last long enough” (p=0.004), “I was satisfied with my sexual performance” (p=0.05), and “I felt confident about performing sexually” (p=0.02). There were no statistical differences in the confidence domain (p=0.89) or self-esteem (p=0.68) and overall relationship (p=0.80) sub-domains.

Conclusions

PP patients reported higher sexual relationship domain scores than ICI patients, while confidence, self-esteem, and overall relationships were similar. Regular use of the SEAR questionnaire may help to identify areas of post-treatment psychosocial needs in ED patients that may benefit from support groups or discussion with a counselor.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific
93 Acceptance and Commitment Therapy to Increase Compliance to Intracavernosal Injection Use (ICI) Following Radical Prostatectomy (RP): Preliminary Results from a Randomized Control Trial
Authors: Nelson C , Tutino R , Pessin H , Joshi N , Schofield E , Mulhall J
Published: April 2022

Introduction

ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low.

Objective

This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP.

Methods

This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner who monitors ICI use, answers questions, and provides education. The interventions are delivered over a year. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for two years. The primary outcomes are number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes are: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).

Results

To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). The mean age was 60±7 years and 81% were married. The mean erectile function grade pre-RP was 8.9±1 (0-10 scale). At 6m, the ACT group utilized more injections/week vs. the EM group (median: 2.06 vs. 1.17, p=0.01) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2).

Conclusions

Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men's satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms.

Disclosure

No
152 Effectiveness of Pudendal Nerve Blocks on Postoperative Pain Control and Reduction in Opioid Usage after Gender-affirming Vaginoplasty
Authors: Chin P. , Yuan N. , Zaliznyak M. , Stelmar J. , Garcia M.
Published: April 2022

Introduction

Postoperative pain control in gender-affirming penile-inversion vaginoplasty (PIV) significantly affects patient experience and satisfaction. With the rise of opioid misuse and over-prescription, non-narcotic adjuncts for post-surgical analgesia are greatly needed. Currently, there is limited data on postoperative pain control after genital gender-affirming surgery (gGAS).

Objective

To evaluate the effects of preoperative pudendal nerve block on post-op patient-reported pain scores and opioid usage.

Methods

We retrospectively reviewed all trans-female patients undergoing PIV (+ creation of vaginal canal) at a single institution from August 2017 to July 2021. We recorded patient demographics, operative details, surgical-site pain (using a Likert scale 0-10; 0=no pain, 10=severe pain), and analgesic medication usage. Baseline demographics, pain scores and opioid usage were compared between patients who received pudendal nerve block preoperatively (immediately before the surgical procedure) and those who did not. Independent sample t-tests were used for all comparisons.

Results

Out of 36 consecutive patients (mean age 36.6 years, mean BMI 25.3 kg/m2) that underwent PIV, 25/36 patients did not have pre-op pudendal nerve block, while the most recent 11/36 patients did. Patient characteristics across cohorts were similar, though the 11 patients who had pudendal nerve block had higher rates of depression (54.5% vs. 28.0%, p=0.043) and hypertension (18.2% vs. 4.0%, p=0.041). Surgical-site pain scores on postop day 0 (POD0) were compared: patients who received pudendal nerve block had 35% lower pain scores than those who did not (3.09 vs. 4.74, p<0.001). Surgical-site pain scores on POD5 were 10% lower in those who received pudendal nerve block (4.16 vs. 4.63, p=0.046). Although patients experienced lower subjective pain scores, average total opioid usage was similar between patients who received pudendal block (MME= 224) versus those that did not (MME= 225).

Conclusions

Our preliminary data suggests that pudendal nerve blocks are safe and effective adjuncts to improve pain control after gender-affirming PIV, thus improving patients’ postoperative experience. This modality should be further investigated and considered for routine usage in vaginoplasty, and other gGAS perioperative pain regimens. Similar opioid usage despite improved pain scores suggests that in-hospital opioid pain regimens should be more closely tailored to patient-reported pain scores.

Disclosure

No
157 An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap
Authors: Yuan N. , Gupta A. , Garcia M.
Published: April 2022

Introduction

Peritoneal vaginoplasty (PV) has been reported for congenital and primary gender-affirming cases, but few have reported its use as secondary vaginoplasty to treat post-op neovaginal canal shortening after penile-inversion vaginoplasty (PIV). Recent adaptations of PV have been modifications of the Davydov procedure, wherein peritoneum adherent to the bladder and rectum are incorporated to line the new terminal apex of the vaginal canal.

Objective

We describe our alternative technique using a urachus-peritoneal hinge flap and discuss proposed advantages.

Methods

We performed retrospective review of all trans-female patients who underwent our PV technique for revision/salvage vaginoplasty from May 2019 to August 2020 (minimum 10 months follow-up). Patients were asked questions about their experience and satisfaction. All cases were performed via combined trans-perineal and laparoscopic (robot-assisted) approaches. Pre-op and post-op neovaginal depth/circumference were recorded. After incision and spatulation of the terminal neovagina, a midline, inferiorly based peritoneal hinge flap (minimum 8-cm width) was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The flap's free end was flipped posteriorly and sutured to the posterior edge of the open canal remnant to form a peritoneum-lined pouch. The pouch's lateral edges were sutured together, using a vaginal dilator as a guide.

Results

Five patients underwent peritoneal vaginoplasty with our technique from 5/2019 to 8/2020. Mean age was 32. All previously underwent PIV for primary vaginoplasty, with loss of neovaginal depth. Pre-op: mean neovaginal depth was 8.6 (±1.8) cm and girth was 12 cm. Immediate post-op: mean depth was 16.8 (±1.2) cm (mean net increase from pre-op: 8.2 cm) and girth was 12 cm. At mean follow-up of 1.4 years, mean depth was 12.8 (±2.4) cm (mean net increase from pre-op: 4.2 cm) and girth was 12 cm. There were no immediate complications. One patient developed anastomotic stenosis at 6 weeks post-op, managed conservatively with dilation under anesthesia. One patient stopped dilating due to a mental-health crisis and lost significant postoperative depth. Three of the 5 (60%) patients report satisfactory vaginal receptive intercourse. The other 2 have not yet attempted vaginal receptive intercourse.

Conclusions

Our PV vaginoplasty technique is a safe and effective option to treat neovaginal shortening after PIV. Advantages include no tension on peritoneal suture lines when vaginal canal is empty and total exclusion of the rectum. This technique also allows for omental interposition. We recognize the natural limited availability of peritoneum and so reserve this technique only for cases where there is adequate residual canal girth and at least 6-7 cm of residual depth.

Disclosure

No
160 Management of New Complications from Prostatic Urethral Lift
Authors: Hakky T.S.
Published: April 2022

Introduction

Prostatic urethral lift (PUL) is a minimally invasive treatment for men with benign prostatic hypertrophy (BPH). This entails placing non-absorbable sutures with a nitinol prostate capsular anchor and a stainless-steel urethral end piece to mechanically open the intraurethral prostate for lower urinary tract symptoms (LUTS). There is a 12% incidence of complications from PUL. Here we present a single center experience with PUL along with management of the first known complication of PUL injuring the penile prosthesis reservoir and also a patient presenting with prostatic urethral adhesion following PUL.

Objective

To present the data of a single center experience with PUL and to document the first known injury of penile prosthesis reservoir from PUL and to discuss techniques and management of prostatic urethral adhesions from PUL.

Methods

A retrospective chart review was performed from the last two years of a single physician andrologic practice. Images and video was taken of the various rare complications encountered.

Results

A total of 63 PUL were performed. 1 patient had sepsis after the procedure. 2 patients had urinary retention that resolved after 7 days of catheterization. Ages ranged from 43-88 years, and prostate size ranges from 22- 90grams with a mean of 44 grams. IPSS score improved by 8 points. One patient was found to have a non-working penile implant 2 weeks after PUL. He underwent penile prosthesis revision and was found to have the PUL in the reservoir. 0 patients had retrograde or anejaculation after PUL. Three patients needed re-treatment after PUL, one opting for PUL the other opting for another modality. One patient who had PUL at another facility underwent intra-urethral prostatic stricture ligation for refractory (LUTS).

Conclusions

PUL is both safe and effective in the treatment of BPH. Caution should be taken in men with penile prosthesis and space of retzius reservoir placement as here we document the first PUL injury of the penile implant reservoir. Prostatic urethral stricture while rare can also occur and is best handled using an athermal technique to open the prostatic fossa.

Disclosure

No
163 Placement of ProACT Device in a Man with Persistent Leakage with AUS
Authors: Fish P. , Bowen A.
Published: April 2022

Introduction

Up to 50% of men who undergo artificial urinary sphincter implantation will need a subsequent surgery within 5 years. Causes for revision include erosion, persistent leakage, urethral atrophy, infection and mechanical failure. We present a case of successful treament of recurrent SUI following AUS revision using the ProACT device. Patient was using 3 pads per day despite functional AUS.

Objective

Demonstrate technique and discuss outcome in patient treated with ProACT therapy following AUS failure.

Methods

Video with narration is used to demonstrate novel technique of using adjustable, inflatable balloons to treat post prostatectomy incontinence in a man who has experienced urethral atrophy due to in situ AUS. Pump was deactivated and small cystoscope was used to avoid damage to device. ProACT placement technique demonstrated including cystogram, flouroscopic guidance and use of specialized implantation tools.

Results

Technical description and visual demonstration of ProACT placement for a patient with persistent SUI following AUS failure. At four months post op patient was pad free without undergoing full AUS revision and associated risks.

Conclusions

ProACT may be a useful option to avoid full revision in patients with persistent or recurrent leakage following artificial urinary sphincter placement.

Disclosure

Yes, this is sponsored by industry/sponsor: Uromedica

Clarification: Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Uromedica
164 SST and The Frozen Pump
Authors: Habashy E. , Kohler T.
Published: April 2022

Introduction

Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during or after penile prosthesis (PP) implantation. The “frozen pump” is a phenomenon that patients experience postoperatively where they encounter difficulty inflating the device due to a rigid capsule formation around the pump leading to pump failure.

Objective

In our video we describe our surgical approach in the management of GH, and the Frankenstein technique we utilize to address a "frozen pump".

Methods

Our video demonstrates our standard technique of using permanent sutures to repair GH with bilateral distal dorsal anchoring sutures and a deep glans suture. It also demonstrates our Frankenstein pump revision technique where a different brand device component may be utilized to replace the original device pump to ease device inflation.

Results

Successful repair of GH/SST deformity and revision of a non-functioning PP pump.

Conclusions

Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP. Using different brand components to revise PP pump can be done without compromise to mechanical function.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Tobias Kohler is consultant for Coloplast
175 Could COVID-19 Induced Endothelial Dysfunction Explain New Onset Peyronie's Disease?
Authors: Rainer Q. , Saltzman R. , Premer C. , Hurwitz B. , Molina M. , Ibrahim E. , Hare J. , Ramasamy R.
Published: April 2022

Introduction

Coronavirus Disease 2019 (COVID-19) is an emerging infectious disease caused by a novel coronavirus (SARS-CoV-2) which has been found to cause systemic inflammation in some patients. Many possible long-term sequelae of COVID-19 have yet to be identified. Since endothelial cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS2) receptors, and SARS-CoV-2 requires both receptors for cell entry, we hypothesized that widespread endothelial damage caused by COVID-19 infection leads to Peyronie's disease (PD).

Objective

New-onset PD after resolved COVID-19 infection was evaluated.

Methods

This study was performed after Institutional Review Board approval. After comprehensive history and physical exam, penile duplex was used to evaluate blood flow and characterize any plaques. International Index of Erectile Function (IIEF) was used to evaluate erectile function. Brachial artery flow-mediated dilation (FMD) and endothelial progenitor cell – colony forming units (EPC-CFU) assays were utilized as measures of endothelial function. Available data from two separate control groups were used for comparisons: “No PD” contains subjects with a history of cardiovascular disease and normal erectile function according to IIEF-EF score (n=27). This group was selected to serve as a negative control with endothelial dysfunction. A second control group “Healthy Controls” was selected as a positive control containing male participants who were free from any significant cardiovascular medical history (n=9).

Results

New-onset PD after resolution of COVID-19 infection was identified in one patient. The penile duplex with erectogenic agents demonstrated normal vascular flow with presence of calcified plaques. The PD group median EPC-CFU levels were 0 as compared to 1.60 in the no PD (negative control) group and 20.00 in healthy (positive) controls. Similarly, median FMD% was impaired in the PD group (2.35%) and no PD group (3.88%) as compared to healthy controls (7.75%).

Conclusions

These findings reveal a novel mechanism for PD after resolution of COVID-19 infection. These findings have significant clinical and biological implications for males with PD and should be considered as a possible sequela of COVID-19 infection.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus
181 Perioperative Morbidity of Feminizing Gender Affirmation Surgery: Analysis of the National Surgical Quality Improvement Program (NSQIP) Database
Authors: Walton A. , Pandit A. , Payakachat N. , Mundinger G. , Raheem O. , Benson C.
Published: April 2022

Introduction

Genital Gender Affirmation Surgery (gGAS) has become increasingly prevalent as a result of increasing insurance coverage and surgeon availability throughout the US.

Objective

To characterize the demographics, trends, and perioperative morbidity of feminizing gGAS among transgender patients in the US using a population data.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was queried to perform retrospective analysis of feminizing gGAS between 2006-2019. Due to a lack of standardized CPT codes for feminizing gGAS, we identified our initial cohort using individual common CPT codes for gGAS, associated with ICD Codes for gender dysphoria. We further differentiated primary gGAS from revision cases by requiring penectomy (CPT 54120/54125) and one vaginoplasty code (CPT 57291, 57291, 57335, 55970) to be included. We characterized baseline demographics, perioperative characteristics, and 30-day complications.

Results

141 transgender patients underwent feminizing gGAS from 2016-2019, after excluding 285 patients, as none were documented before 2016. The majority of cases were in 2018 (n=57, 40.4%) and 2019 (n=41, 29.1%). Most patients were operated on by plastic surgery (85%), compared to urology (15%). Mean age was 39.6 years (SD=13.8), and mean BMI was 26.3 (SD=5.5). Gender was classified as female (77.3%), male (22.7%) and non-binary (0.7%). 78% were white, 7.8% African American, 7.1% Asian, and 7.1% other. The most common co-morbidities were hypertension (7.8%), diabetes (6.4%), and smoking (5%). The mean operative time was 339 min (SD=85.7min) and mean hospitalization was 6.1 days (range 3-24 days). There were 14.6% with ³1 complication (14.6%). Wound disruption occurred in 12 patients (8.5%), 4 (2.8%) UTIs, 3 (2.1%) superficial wound infections and 1 (0.7%) deep wound infections, and 3 (2.1%) required blood transfusion. Among 12 patients (8.5%) that returned to OR (average of 12.6 days), 50% for wound disruption and 6 patients were readmitted at mean 19.4 days from surgery.

Conclusions

This is the first characterization of patients undergoing femininizing gGAS utilizing the NSQIP database. There continues to be increasing volume of patients undergoing primary gGAS, which appears to be safe with acceptable rates of complications and reoperations. Further study utilizing claims-based population databases may provide a better understanding of the scope of feminizing gGAS.

Disclosure

No