bluuebunny/crossref_metadata_2025 huggingface dataset:
(343) Predictors of Corporo-venocclusive Dysfunction (CVOD) in Men with Bilateral Nerve-sparing Radical Prostatectomy (RP)
Authors: Flores J , Salter C A , Benfante N , Schofield E , Mulhall J P
Published: May 2023

Introduction

Nerve-sparing status (NSS) during RP is a significant predictor of erectile function recovery (EFR). Poor nerve sparing is associated with collagenization of cavernosal smooth muscle and CVOD development with typically poor response to PDE5 inhibitors (PDE5i) and intracavernosal injection therapy (ICI).

Objective

This study aimed to define factors predictive of CVOD in men with bilateral NS RP.

Methods

Study population consisted of (i) men who underwent bilateral NS (defined by the surgeon using an institutional grading system) RP (ii) with poor response to PDE5i and ICI (iii) ≥2 years post-RP (iv) who underwent penile duplex Doppler ultrasound (DUS) (v) using a vasoactive agent redosing schedule. CVOD diagnosis was made with end-diastolic velocity (EDV) values ≥5 cm/sec bilaterally. ADT and radiation therapy were exclusions. We used multivariable modeling to define factors predictive of CVOD. Factors included in the model: patient age, history of diabetes, history of obstructive sleep apnea, number of vascular comorbidities, baseline EF, peri-RP total testosterone (T) level, and total T at DUS (within 3 months).

Results

201 men with a mean age of 66 ± 7 years. 25% of the patients reported 3 or more vascular comorbidities, 17% had diabetes, 36% obstructive sleep apnea, 39% were current or former smokers. Mean baseline PSA and pre-RP total T was 6.7 ± 6 ng/mL and 410 ± 211 ng/dL, respectively. Median baseline EFD score was 24 (13, 29). 49% of the men had an erection less than penetration rigidity during the DUS procedure with a mean total dose administered of 87 ± 21 units of trimix. 69% received 100 units. CVOD was diagnosed in 76%. Mean total T at DUS was 386 ± 177 ng/dL. 32% had low T. Significant predictors of CVOD after RP in men with BL NSS were: OSA (OR = 3.8, 95% CI = 1.7-8.7), ≥ 3 vascular comorbidities (OR = 5.0, 95% CI = 1.7-14.8), age at the time of DUS (per 10 years increase, OR = 1.9, 95% CI = 1.2-3.0), and pre-RP EF domain score (per 1 unit increase, OR = 0.93, 95% CI 0.88-0.98). There was a signal that in a larger sample size, diabetes may be a significant predictor of CVOD in this group of patients (OR = 2.7, 95% 0.9-8.0).

Conclusions

Baseline clinical comorbidities pre-RP have a significant impact on EFR post-RP, in particular, the presence of venous leak. Despite BL NSS, older patients, men with OSA, higher number of comorbidities pre-RP, and lower pre-RP EF increased the likelihood of developing CVOD post-RP.

Disclosure

No
(348) Implementation of Opioid- Free and Opioid-Reduced Protocols for Postoperative Pain Management After Penile Prosthesis Surgery
Authors: Henry A , Novicoff W , Kennady E , Ali M , Smith R , Baumgarten A , Ortiz N
Published: May 2023

Introduction

Postoperative pain management after (PP) penile prosthesis is challenging and it has traditionally required opioid medication. In light of the ongoing nationwide opiate epidemic and in an effort to reduce the risk of postoperative opioid dependence, urologic prosthetic surgeons have sought to establish opioid-free and/or opioid-reduced protocols (OFP, ORP respectively) for PP postoperative pain management.

Objective

This study seeks to investigate the patterns of adoption of OFP or ORP among surgeons who perform PP surgery and potential barriers to their implementation.

Methods

A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) via email. The survey was administered via Qualtrics. T-test was used to analyze survey responses.

Results

43 urologists responded to the survey, with representation from every American Urologic Association geographic section. Most respondents (73.18%) performed penoscrotal PP and 43% of respondents performed more than 30 PP per year. OFP was used most of the time by 24.39% of respondents and ORP was used most of the time by 73.18%. No significant relationship was found between the use of an OFP/ORP and geographical region, number of implants performed per year, surgical approach, or location of reservoir placement. Of the respondents using an ORP, 100% prescribed 10 doses of opioid medication or less upon discharge. 41.51% of respondents used an OFP/ORP from published literature and 9.43% consulted their local anesthesia or pain management department. The most commonly used modalities of non-opioid analgesia were: non-steroidal anti-inflammatories (95.1%), acetaminophen (87.8%), dorsal penile block (80.4%), gabapentin (46.3%), and pudendal block (43.9%). Following initiation of an ORP/OFP, 9.3% reported an increase in phone calls and 11.6% reported an increase in refill requests. There were no reports of increased patient dissatisfaction. Most respondents (65.8%) were extremely satisfied with their protocols.

Conclusions

OFP/ORP after PP surgery appear to be widely adopted by the urologic prosthetic community without a significant increase in patient or surgeon dissatisfaction.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast (ASB).
(350) Narcotic Requirements and Operative Outcomes of a Pudendal Nerve Block Prior to Primary Inflatable Penile Prosthesis Implantation in a Multiethnic Population
Authors: Labagnara K , Loloi J , Babar M , Aalami Harandi A , Zhu M , Salami A , Patel R , Bernstein A , Davuluri M , Davila J , Maria P
Published: May 2023

Introduction

There are various analgesic regimens for post-operative pain control following inflatable penile prosthesis (IPP) implantation. Specifically, post-operative pain control with opioids is a common practice, but efforts to minimize narcotic usage are vital given the current opioid epidemic in the United States. Pudendal nerve block (PNB) provides regional perineal and penile anesthesia and represents an attractive option to maximize pain control while minimizing post-operative narcotic use. However, there is a paucity of studies describing whether utilization of PNBs decreases intra- and post-operative narcotic requirements following IPP implantation.

Objective

To determine whether PNB utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. Secondary objectives were to assess PNB utilization on intra-operative and 30-day safety outcomes.

Methods

A single institution retrospective study was conducted of patients who underwent primary IPP implantation between December 2015 and February 2022. Demographic data, intra-operative characteristics, and outcome measures were extracted from electronic medical records. Baseline characteristics of PNB (yes or no) were summarized and analyzed using a Student’s t-test, Chi-square test, or Mann-Whitney U for non-normally distributed variables. PNB usage and PACU opioid administration (yes or no) were analyzed using binary logistic regression for univariate and multivariate analysis.

Results

A total of 363 patients were included, 294 (81.0%) in the PNB group and 69 (19.0%) in the non-PNB group. The majority of patients were of Hispanic race (62.3%). History of chronic pain (17.7% vs. 7.2%, p=0.03) and hyperlipidemia (52.0% vs. 34.8%, p=0.01) were more prevalent in the PNB group. Significantly more IPPs in the PNB group had cylinders measuring 20 centimeters or greater (57.1% vs 41.2, p=0.017). Estimated blood loss of 50ml or greater (43.1% vs. 20.0%, p<0.001), PACU narcotic usage (61.6% vs. 75.4%, p=0.040) and time (minutes) spent in the PACU (144 [111-185] vs. 238 [162-307], p<0.001) were all significantly lower in the PNB group. There were no significant differences in postoperative and 30-day safety outcomes. On univariate analysis, both PNB (OR=0.52, p=0.043) and age above 65 (OR=0.53, p=0.004) were associated with a lower likelihood of receiving opiates in the PACU, while only age remained significant (OR=0.53, p=0.006) on multivariate analysis.

Conclusions

Pre-operative PNB decreases intra-operative estimated blood loss, post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation. Thus, PBN represents a potentially attractive, non-opioid means of analgesia in patients undergoing primary IPP surgery.

Disclosure

No
(373) Sexual Health Literacy Confidence Among Urology Resident Physicians
Authors: Horwitz R , Lewis K C , Khooblall P , Haile E , Lundy S D , Bajic P
Published: May 2023

Introduction

Despite the importance of sexual health, physicians may not be adequately equipped to diagnose and treat sexual dysfunction. Topics related to healthy sexual function (pleasure, masturbation, communication, sex toys/tools, and anal sex practices) are largely omitted from medical education. It is vital that urologists are trained to ask detailed questions about sexual health, counsel on healthy sexual habits, and identify and treat sexual dysfunction.

Objective

To determine the level of comfort among urology residents in taking a comprehensive sexual health history, identifying sexual dysfunction, and treating patients of various gender identities and sexual orientations.

Methods

An anonymous electronic survey was distributed to current urology residents in the United States. The survey contained five demographics questions and twenty-three questions tied to sexual health competencies. Participants were asked to provide their education year, current age, medical school location, residency location, and estimated hours of sexual health education during training (excluding STI/STD content). Survey questions targeted previously established sexual education competency domains.

Results

A total of 52 urology residents participated in the study. Participant post-graduate years ranged from 1-6. 61.5% of participants stated they received only 0-3 hours of formal sex education during medical school and 46.3% reported having any formal sex education during urology residency. 80% of participants felt comfortable asking patients about self-erogenous stimulation, but only 27% of responders felt comfortable answering questions about anal stimulation devices, and 35% of responders felt comfortable answering questions about vaginal stimulation devices. Greater than 94% of residents feel “very comfortable” or “somewhat comfortable” with describing male sexual dysfunction and performing physical exam for a man with sexual dysfunction, but only 59% felt the same towards female sexual dysfunction. When describing medicines used for sexual function, 100% of residents are comfortable doing so for men, but only 63% are comfortable doing the same for women. When counseling transgender males or females on sexual practice/therapies/surgeries, only 29% of residents felt comfortable.

Conclusions

There are knowledge gaps in sexual medicine literacy confidence among urology residents surveyed. Lack of a comprehensive sexual health education curriculum during medical training may be affecting patient care. Women and sexual and gender minority (LGBTQ) patients may be at higher risk of being treated by a urologist without comfort in managing their sexual health. Sexual health education optimization during urology residency has the potential to promote improved understanding of the sexual health of women and sexual and gender minorities and improve the evaluation and management of sexual dysfunction in general.

Disclosure

No
(385) The Bulboclitoral Erectile Tissues: A Previously Unacknowledged Organ at Risk During Radiotherapy
Authors: Greenwald L , Reidenberg J S , Downes M , Weiner S , Marshall D
Published: May 2023

Introduction

Loss of sexual function can be a devastating side effect of the radiotherapy techniques used in the treatment of pelvic area tumors. Direct damage to the erectile tissues caused by off-target effects of radiation contributes to this loss of function. Advances in radiation techniques allow for greater tissue sparing, offering the potential to minimize tissue toxicity during treatments for pelvic cancers. In radiation oncology practice, specific attention is given to preserving sexual function in well characterized anatomic areas of male sexual function; however, preservation of clitoral structures involved in sexual function has not been well explored. Incorporating previously unacknowledged sexual structures such as the clitoris and vestibular bulbs (bulboclitoris for short) into radiotherapy treatment planning may improve our ability to preserve the function of these structures, including arousal and orgasm, after pelvic radiotherapy. Such an approach normalizes and affirms sexual pleasure as an important aspect of sexual health in cancer survivorship for women and gender-diverse persons.

Objective

We aim to explore the anatomic and radiologic characteristics of bulboclitoral sexual structures to shed light on their potential therapeutic applications in radiotherapy.

Methods

We evaluated the presence and configuration of the bulboclitoral erectile tissues and their proximity to other organs in a multi-modality study. The morphological characteristics were assessed in human cadaveric specimens using gross anatomic dissection and cross-sectioning as well as cross-sectional imaging using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) (N=3).

Results

We present the CT, MRI, gross cross-sections, and 3D reconstruction of the bulboclitoral sexual structures. The presence and morphology of the female erectile tissues and adjacent structures are consistently demonstrated across modalities to inform anatomic delineation on radiotherapy planning scans.

Conclusions

The bulboclitoral erectile tissues are important structures in the pelvic region that have an essential role in sexual function. Attention to these previously unacknowledged structures has the potential to help improve patient outcomes in radiotherapy. In order to make this step, radiation oncologists can learn about the structures and their functions, and develop and apply advanced techniques to help preserve their integrity. Empowering radiotherapy clinicians with evidence for incorporating the anatomy, physiology and pathophysiology of organ function related to sexual pleasure in female persons with cancer provides an opportunity for tailored clinical decision-making and a more equitable distribution of advanced technologies that may preserve sexual function after cancer treatment.

Disclosure

No
(411) The “Unfolding” Technique for Penile Prosthesis Implantation in Post-priapism Corporeal Fibrosis
Authors: Abdel Rassoul M
Published: May 2023

Introduction

`- In neglected cases of ischemic priapism, there is usually severe corporeal fibrosis that can render penile prosthesis implantation later on extremely difficult. - Although many researchers described different approaches to overcome difficulties during surgery, none of them offered satisfactory results.

Objective

`- to describe a new technique to insert a large sized penile prosthesis in patients suffering from ED after neglected ischemic priapism with resultant severe corporeal fibrosis.

Methods

`- A new surgical technique was done in 15 patients suffering from ED after prolonged ischemic priapism with severe corporeal fibrosis. - Surgery starts by a circumcision incision, complete degloving & delivery of the penis through a midline perineal incision. - The penile urethra is then dissected away from the ventral surface of both corpora cavernosa - A midline ventral incision is done between both corpora cavernosa. This incision is then deepened till it reaches the inner surface of the tunica albuginea. At this point, the scalpel is then rotated 90 degrees to unfold the core of fibrosis into a flat sheet continuous with tunica albuginea. - The process is then repeated on the other side. - The proximal crura are then dilated in the usual manner by metal dilators. The distal part of the corpora are bluntly dilated by the closed blades of scissors. - After inserting the penile prosthesis, both sheets of fibrosis are closed over both prosthetic rods in the midline and the penile urethra is then fixed back to its position. - The penis is then retuned to its normal anatomical site & the skin is closed.

Results

`- Successful surgery was achieved in 13 out of 15 patients (86.7%). - 2 patients developed infection that necessitated surgical removal of the rods. - no incidence of urethral injury, crossover or corporal perforation

Conclusions

`- The new “un-folding” technique is feasible and useful technique in patients with ED after prolonged ischemic priapism - The incidence of complications esp. urethral erosion, crossover and corporal perforation.

Disclosure

No
(423) A Case Series of Successful Off-label Use of Flibanserin
Authors: Trowbridge P , Padhye M , Rubin R
Published: May 2023

Introduction

Flibanserin was the first FDA approved drug for hypoactive sexual desire disorder (HSDD) in premenopausal women, but was initially studied as an antidepressant without concern for age or gender. Flibanserin acts as partial agonist at the serotonin receptor 1A and antagonist at serotonin 2A receptor. The mechanism of action is thought to be due to an increase in dopamine and norepinephrine. Post hoc analysis during the pivotal trials showed improvement not just in desire, but in all domains of the Female Sexual Function Index (FSFI) including orgasm, arousal, lubrication and satisfaction. Off label use of flibanserin therefore is of interest to sexual medicine providers.

Objective

Described here, are four off label uses for flibanserin with successful outcomes in patient’s symptoms and quality of life, including post-orgasmic illness syndrome (POIS), low libido in a eugonadal male, a postmenopausal female with HSDD, and a patient with post-finasteride syndrome (PFS).

Methods

The first case is of a 40-year-old male patient who presented with a 10 year history of acquired POIS, with significantly debilitating symptoms lasting 1 week after orgasm. After trying a number of different multimodal treatment approaches he finally was on a regimen of Bupropion, Lexapro, Silodosin, Ritalin and Tramadol with a reduction in the duration of his symptoms from 1 week to 4 days, without a change in symptom intensity. Patient was then trialed on 200mg gabapentin nightly and 100mg flibanserin nightly, with progressive discontinuation of prior medications. The second patient, is a 77-year-old hypersexual, postmenopausal woman with a significant trauma history, who presented with gradually worsening HSDD despite adequate lubrication on estring, who was started on 100mg flibanserin nightly. Patient 3 is a 51-year-old male who presented with a 1 year history of low libido and mild erectile dysfunction despite normal testosterone levels and minimal improvements with sildenafil, who was trialed on 100mg flibanserin nightly. The fourth case involves a 26-year-old male presenting with PFS symptoms of erectile dysfunction, decreased libido, genital shrinkage, testicular pain, anxiety and brain fog. Patient had some improvement of erections post discontinuation of finasteride, but was only able to achieve full erection with use of tadalafil. Patient was trialed on 2 months of 100mg flibanserin.

Results

All four of these patients experienced significant improvement in their presenting symptoms after starting flibanserin nightly. Patient 1, with POIS, had markedly reduced symptom intensity and reduced duration of POIS from 7 days to 1 day. Patient 2 and 3 regained prior libido and quality of life within 2-3 months. Lastly, patient 4 experienced marked improvement in sleep, brain fog, libido and erectile function.

Conclusions

These cases indicate that flibanserin may be useful to more than premenopausal women and should be studied as a medication with additional pro-sexual affects like bupropion and buspar.

Disclosure

No
(464) Impact of Training on Confronting Discrimination and Harassment by Patients and Peers
Authors: Findlay B , Byrne E , Bearrick E , Alom M , Helo S
Published: May 2023

Introduction

Discrimination and sexual harassment within the workplace have a negative impact on well-being and productivity and are often underreported due to lack of comfortability in confronting the offender.

Objective

We aim to assess the prevalence of these abusive behaviors within a urology department and the impact of a dedicated training session on comfortability reporting/confronting discrimination and harassment.

Methods

Employees within a urology department at a single institution were invited to take a survey regarding discrimination and harassment both before and after a dedicated training session on reporting and confronting these behaviors. Statistical analyses were performed between pre- and post-survey groups, genders, and roles within the department.

Results

A total of 166 employees completed the pre-training survey, while 79 (47.6%) completed the post-training survey. 116 (69.9%) respondents identified as female. Roles within the department included physician (48/166, 28.9%), advanced practice provider (21/166, 12.7%), nurse (42/166, 25.3%), and nonclinical staff (51/166, 30.7%). The training demonstrated a positive impact in respondent comfort level with addressing gender discrimination, where 19/23 (82.6%) people who answered neutral/ disagree/strongly disagree changed their answer to agree/strongly agree compared to 7/56 (12.5%) who changed their answers in the opposite way (p=0.02). More women reported experiencing sexual harassment at least once a year compared to men (38.6% vs. 16.7%, p<0.0001). Patients were the most commonly reported offenders of abusive behaviors towards staff.

Conclusions

Specific training on strategies for addressing abusive behaviors can help employees feel empowered to confront gender discrimination by both patients and their peers.

Disclosure

No
(469) The High Incidence of Female Orgasmic Disorder Secondary to Premature Ejaculation in South Florida
Authors: Dominguez-Bali A , Ramraj C , Dominguez-Bali C
Published: May 2023

Introduction

Premature ejaculation (PE), according to the ISSM Committee, is defined as ejaculation with vaginal penetration that always or nearly always occurs prior to or within about one minute from the beginning of a sexual encounter, together with the inability to retard ejaculation with vaginal penetration. As a result, the personal life of an affected individual may be negatively impacted, with the consequences of distress, bother, frustrations, and/or avoidance of sexual intimacy. However, there are multiple factors to consider and not all sexologists, psychologists, and therapists agree about a clear and complete definition of PE. This, in turn, makes it more difficult to have clear statistics of the incidence, prevalence, and frequency of this disorder. On the other hand, Female Orgasmic Disorder (FOD) is defined as difficulty, delay, or inability for a woman to reach orgasm in a sexual encounter or the reduced frequency and/or intensity of orgasm. While PE and FOD are usually described separately in the medical literature, we have found in both the sexological literature and in practice that women with FOD are frequently the partners of men with PE.

Objective

The objective of this review is to address the increased incidence of FOD secondary to PE in the South Florida Latin-American population, its impact in the sexual function of both male and female partners in their relationship, and the possible reasons for the difference between the Latin-American community and the General population of the United States of America.

Methods

This is a retrospective review of the sexological literature and the statistics we have collected from patients over the last 20 years, in which around 80% of cases of women with FOD are due to PE in their partner.

Results

Nationally speaking, the frequency of FOD secondary to PE has been reported to generally run between 35-50% in reproductive aged women. Throughout the years we have noticed that this frequency is markedly higher in the Latin-American population of South Florida, reaching 79.6% of cases.

Conclusions

We do not have a clear explanation for this important difference between the General population of the United States and the Latin-American population of South Florida, but we know that the Latin-American population in this area is exposed to a great number of stressors. One such set of stressors that may be a contributing to the increased incidence is known as the “Immigrant’s Syndrome,” a set of circumstances which includes sexual dysfunction as one of its components.

Disclosure

No
(471) The Transfacial Fixation of an Ectopic Low Submuscular Reservoir: A Novel Approach to Inflatable Penile Prosthesis Reservoir Placement
Authors: Reddy A , Khera M , Rakic N , Khoei A , Bansal U
Published: May 2023

Introduction

Ectopic reservoir placement has become a more routine practice among high-volume penile prosthesis implanters. In particular, the low submuscular approach has gained considerable popularity given its safe location away from structures of concern such as the iliac vein or bowel, which can frequently be in the proximity of reservoirs placed in the traditional Space of Retzius position in patients with prior pelvic procedures such as a radical prostatectomy. However, the low submuscular approach is not without its own risks, most notably, herniation of the reservoir to an unintended location. In order to maximize the benefits of submuscular reservoir placement and minimize risk for herniation, we describe a novel approach to low submuscular reservoir placement.

Objective

The objective of this study is to present outcomes data on inflatable penile prosthesis patients who underwent low submuscular (LSM) reservoir placement with transfascial fixation (TFF).

Methods

A retrospective review was conducted on patients who underwent an IPP placement using the LSM with TFF technique between June 2019 and March 2022 by a single, high-volume surgeon at a tertiary medical center. Preoperative patient characteristics were collected, and patients then conducted a telephone interview with a modified questionnaire to assess satisfaction with the IPP and reservoir concealment.

Results

A total of 34 patients underwent IPP surgery with low submuscular reservoir placement with TFF of which 29 completed the questionnaire (85.2%). The average age of patients was 68.3 years, and 61.5% of patients had undergone a radical prostatectomy. Overall satisfaction with the penile implant was 4.1 (out of 5). Eight patients (26%) were able to palpate the reservoir, and four patients (15.4%) were able to visualize the reservoir impression below the abdominal skin. However, overall satisfaction with reservoir concealment was 4.6 (out of 5) (Table 1). No surgical revisions were required and there were no surgical complications such as bowel obstruction, herniations, bladder erosion, or vascular injuries.

Conclusions

Low submuscular IPP reservoir placement with TFF is an alternative approach for reservoir placement with a high degree of patient satisfaction, decreased risk for reservoir herniation, and significant ease of placement compared to alternative methods in the literature.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific
(474) Trends and Costs of Ambulatory vs Inpatient Penile Prosthesis Placement
Authors: Brown W , Marte J , Taylor J , Ha A , Kerr P , Joice G
Published: May 2023

Introduction

Current literature is limited in assessing nationwide trends of penile prosthesis (PP) placement in the United States largely due to a lack of data on outpatient PP placement. Particularly no nationwide comparison of ambulatory surgery center (ASC) versus inpatient hospital (IH) PP placement has been published.

Objective

Our objective is to determine the trends of PP placement in ASCs vs IHs utilizing representative nationwide data. Additionally, we examined patient demographics that are associated with the setting for PP placement.

Methods

Inpatient and outpatient encounters for PP placement between 2016 and 2019 were analyzed using data from the Nationwide Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) from the Healthcare Cost and Utilization Project (HCUP). These are the largest publicly available inpatient and ambulatory surgery databases available in the United States. PP operations were identified by CPT and ICD-10-PCS codes. Subsequent analysis was performed using the established weighting provided by the HCUP, which utilizes stratified cluster sampling to create national estimates. Comparisons of demographics were performed using t-tests and chi-square tests with a p-value for significance <0.05.

Results

Over the study period, there were 67,722 PP placements in the United States. The percentage placed in ASCs was 93.1%. In 2016, 16,290 PP placements occurred, of which 92.3% were placed in ASCs. Comparatively in 2019, there was a 7.3% increase (17,473) in the number of PP placements, with 94.5% placed in ASCs (p<0.01). Over the study period, 33,008 PP placements were performed in the South (93.8% ASCs), 12,481 in the Midwest (94.6% ASCs), 12,192 in the Northeast (92.4% ASCs), and 10,040 in the West (90.1% ASCs, p<0.01). The average age of patients receiving a PP placement was 64.4 in ASCs compared with 62.5 in IHs (p<0.01). The average cost associated with PP placement in ASCs was $25,935, about half the cost of inpatient settings, which averaged $51,594 (p<0.01). Of all PP implants, the primary payer was medicare for 57.1% (38,660; 93.1% ASCs), medicaid for 4.4% (2980; 86.6% ASCs), private for 33.6% (22,778; 94.3% ASCs), and self-pay for 1.1% (768; 90.9% ASCs, p <0.01).

Conclusions

Our results suggest that the number of PP placements is consistently rising each year, with an increasing majority of PP placements performed in ASCs. The procedure costs roughly half on average when performed in ASCs compared to IHs. Further investigation is needed to compare complication rates and outcomes of PP placements in ASC versus IH.

Disclosure

No
(477) Ablation Vaginectomy is a Safe and Effective Technique in Transmasculine Gender Affirmation Surgery
Authors: Lee W G , Schirmann A , Ralph D , Christopher N
Published: May 2023

Introduction

Genital gender affirmation surgery ameliorates gender incongruence with the aim to align an individual’s genital appearance more closely to their experienced gender identity. Vaginectomy is commonly requested because it allows closure of the vaginal vault resulting in a masculine appearance to the perineum. Vaginectomy also allows a more appealing sac-like scrotoplasty and may reduce the risk of urethral complications. Transvaginal, laparoscopic (often combined with transvaginal) and robotically assisted approaches have been described. The transvaginal approach involves the excision of vaginal mucosa but blood loss may be significant and there is a risk of injury to adjacent organs like the bladder or rectum. Alternatively, the vaginal mucosa can be obliterated by high power electrocautery without excision. This technique has not been formally described in the literature before.

Objective

Pilot study to describe the technique for ablation vaginectomy (AV) and to assess the safety and efficacy of AV compared to traditional transvaginal excision vaginectomy (EV).

Methods

Retrospective review of a comprehensive prospective database and supplemented by medical records of transgender and non-binary persons requesting vaginectomy for gender affirmation surgery. AV was performed using high power electrocautery while EV was by a transvaginal approach. Follow-up was 30 days post-surgery. Data were reported as mean (standard error) unless specified otherwise.

Results

A hundred and thirty-seven patients were included in the study (62 following AV, 75 following EV). The median age (interquartile range) of both cohorts were similar [AV, 38 years (29-48); EV 37.7 years (31.5-43)]. Patients who underwent AV had a higher BMI but despite this, they had a lower intra-operative blood loss (99.8 ± 12.7mL vs 646.7 ± 63.4mL) and post-operative drain loss (90.9 ± 11.6mL vs 242.8 ± 23.6mL). More patients following EV required a transfusion (n=11) of 2.34 ± 0.5 units of packed red cells. Six patients had an intraoperative complication during EV (none for AV). Two patients had a recognised urethral perforation (one combined with a bladder injury) and 3 others had a bladder injury. All were repaired at the time. Complication rates after 30 days were similar although there was a trend for higher complications following EV (24% vs 11.3%, p=0.06). These were all related to bleeding and haematoma formation with 3.4% (AV cohort) and 8% (EV cohort) Clavien-Dindo grade 3b complications.

Conclusions

AV may be a feasible and safe approach when requested for gender affirmation surgery. Further prospective data with longer follow-up are required.

Disclosure

No
(498) Take it or Leave it? Comparison Between Drain and Retain Versus Reservoir Recycling in Inflatable Penile Prothesis Revision
Authors: Amini A , Nealon S , Badkhshan S , Sanders S , Langford B , Vandyke M , Morey A
Published: May 2023

Introduction

There are three strategies for managing an implanted urologic reservoir during inflatable penile prothesis (IPP) revision. The original reservoir can be removed, deactivated and left in place (drain and retain), or validated and reconnected to an IPP system (reservoir recycling). Although complete removal of a reservoir would prevent the potential complications of a retained device, the formation of a surrounding fibrotic capsule leads to complete removal being less popular among providers compared to drain and retain or reservoir recycling. We sought to evaluate the long-term complications and efficacy of these approaches.

Objective

To compare the efficacy and safety of the drain and retain and reservoir recycle approaches to IPP revision against the gold standard of full device replacement.

Methods

We performed a retrospective chart review of our large, single-surgeon tertiary referral center penile prosthesis database between 2007-2022 to identify all individuals with a retained or recycled reservoir. Only those who had undergone appropriate follow-up and had complete documentation about reservoir handling were included in the study. Reservoir-related complications, mechanical failures, and device infections were compared between the retained, recycled, and full replacement groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were assessed using a Student’s T-test.

Results

There were 140 patients who met inclusion criteria with 48 retained reservoirs, 30 recycled reservoirs, and 62 full replacements. The average age of a reservoir when it was recycled was 4.3 years. Retained and recycled reservoir groups had similar mean follow-up duration, time to revision, and intraoperative time when compared to the full replacement group (Table). Most reservoirs (91% of retained, 90% of recycled, 90% of full replacement) were implanted using the high submuscular technique. Our institution’s virgin IPP implant infection rate was 2.6%. When compared to the full replacement group, infection, mechanical failure, and revision rates were similar for both the retained and recycled reservoir groups (Table and Figure). There was only one verified post-revision reservoir leakage from a recycled reservoir, but no instances of reservoir herniation or reservoir-related bowel complications between the three groups.

Conclusions

There was no difference in reservoir-related complications, mechanical failure, or infections when comparing the drain and retain or reservoir recycle groups to the full replacement group. Reservoir drain and retain and recycling are both safe and effective management options in IPP revision surgery.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(502) Arista™ Hemostat Associated with Decreased Odds of Infection and Reoperation Following Inflatable Penile Prosthesis Surgery in a Diverse, Multiethnic Academic Center
Authors: Patel R , Labagnara K , Loloi J , Babar M , Harandi A , Zhu M , Salami A , Davila J , Maria P
Published: May 2023

Introduction

Using hemostatic agents to manage intraoperative bleeding or assist in surgical closures is well established practice. Currently, several hemostatic agents such as Arista™, Surgiflo®, and Surgicel® are available for surgeon use when placing inflatable penile prosthesis (IPP). However, the effect of these agents on postoperative infection remains to be seen. Thus, we conducted a study to compare postoperative infection and reoperation rates of Arista™ to other hemostatic agents.

Objective

Primary objective was to determine if use of Arista™, when compared to other hemostatic agents, was associated with decreased rates of infection and reoperation in patients from a diverse, multiethnic population undergoing a primary IPP implantation.

Methods

A single institution retrospective study of patients who underwent IPP implantation between December 2015 and February 2022 from a single surgeon was conducted. Patients were sorted into groups based on use of intraoperative hemostatic agents. Demographic data, intra- and peri-operative patient characteristics, reoperation, and post-operative infection information was extracted from electronic medical records.

Results

A total of 434 patients undergoing primary IPP (95.4% Coloplast and 4.6% AMS devices) met inclusion criteria; of which, 158 (36.4%) received Arista™ and 276 (63.6%) received other hemostats such as Surgiflo®, and Surgicel®. There was no significant difference between age, race, preferred language, BMI, or smoking status between the Arista™ and other hemostat groups. Cardiovascular disease (CVD) and diabetes were prevalent in 76.7% and 56.3% of our sample, respectively. A vast majority (84%) of CVD patients had concomitant diabetes. Median Operative time was significantly shorter in the other hemostat group compared to the Arista™ group (62 minutes vs. 75, P <0.001). There was no significant difference in post-operative instances of urinary retention, emergency department visits, or readmission between the two hemostat groups. Multivariable model controlling for age and CVD (Table 1) revealed that Arista™ was associated with significantly decreased odds of postoperative infection and reoperation when compared to other hemostats (OR = 0.36; 95% CI (0.14 – 0.97), P=0.04). Conversely, active smoking were associated with significantly higher odds (OR = 3.92; 95% CI (1.39 – 11.04), P=0.01).

Conclusions

Our retrospective study indicates that use of Arista™, regardless of patient CVD status, may lead to decreased infections and subsequent reoperations. Prospective randomized control trials should be pursued to adequately assess the benefits of Arista™ compared to other hemostatic agents.

Disclosure

No
(504) Subinguinal Microsurgical Cremasteric Muscle Division for Painful Retractile Testis: Single Center Experience
Authors: Abello A , Carrasquillo R J
Published: May 2023

Introduction

Cremasteric muscle division or release is a procedure performed in patients with chronic orchialgia associated with hyperactive cremaster muscle reflex who do not respond to medical therapy. This condition was first described in the literature by Dr. Thomas in 1927 and the first procedures releasing or removing cremaster muscle were first described in the 1930s. Nowadays, cremasteric muscle division is usually performed with a surgical microscope to improve accuracy and avoid injury of cord structures. However, data about outcomes of this procedure are sparse. To our knowledge, the only series of cases was reported by Dr. Kavoussi in 2019 who reported resolution of retraction in 100% of the patients that had this procedure and resolution of orchialgia in 92% of them.

Objective

Our main objective was to describe and evaluate outcomes of microsurgical cremasteric muscle division in a men’s health practice in Boston, MA and to determine if prior results described in the literature are similar to our current experience.

Methods

We performed a retrospective review of cases performed in our institution between 2018-2022 and recorded different outcomes including post-operative pain, post-operative physical exam, ED visits and complications.

Results

We performed a total of 4 cremasteric muscle divisions for unilateral retractile testis in 3 and bilateral retractile testis in 1 of the patients. All of the cases had retraction of the testis with reproducible findings on preop physical exam, and all of them endorsed pain and discomfort associated with retraction. The patient age ranged 21 to 56. All cases were performed using a surgical microscope. After a median follow-up of 52 days, 100% of the patients had improvement in the position of the testicle with no further episodes of retraction, and 75% (3/4) had complete resolution of pain. Regarding complications, only 1 patient had an episode of mild epididymitis that improved with a short course of NSAIDS and there were no visits to the emergency department or other complications.

Conclusions

Our experience is similar to prior case series reported in the literature showing resolution of testicular retraction in all the patients that had microsurgical cremasteric muscle release and resolution of pain in the majority of the cohort with a low rate of post-operative complications. Future multicenter studies with a larger sample size should be performed to confirm these results, compare outcomes to other more conventional approaches such as scrotal orchiopexy, and to explore preoperative characteristics associated failure to resolve pain. In addition, future studies should assess differences in outcomes in procedures using surgical microscope compared to the traditional open approach.

Disclosure

No
(520) The Use of Gracilis Muscle Flap in Radial Forearm Free Flap Phalloplasty to Decrease Urethral Fistula Rate: Initial Outcome
Authors: Abdel Rassoul M , El-Shorbagy G , El-Ghoneimy M , El-Sayed A , Fayad A , Abdel-Rahman S , Abdel-Hamid M
Published: May 2023

Introduction

`- Chang and Hwang, in 1984, described the technique of Radial Forearm Free Flap Phalloplasty (RFFFP). It is now considered to be the standard surgery for phallic reconstruction. Urethral fistula is the most common complication reported in RFFFP and may reach up to 60-70%. Most commonly, the fistula site is at the anastomosis between the native urethra and the neo-urethra.

Objective

`- to study the impact of gracilis muscle flap wrapping around the native urethra/neo-urethral anastomosis on decreasing the fistula rate.

Methods

`- A prospective study was conducted at our urology department, from January 2018 till December 2020. - Patients presenting with a micropenis (Stretched penile length <7 cm) underwent RFFFP with gracilis muscle flap wrapping. - The free-flap was harvested from the non-dominant forearm. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein, and the medial and lateral antecubital nerves with the ilio-inguinal and the dorsal penile nerves respectively. - A pedicled gracilis muscle flap was then wrapped around the neo-urethera/native urethral anastomosis to assess its possible role in decreasing the postoperative urinary fistula rate.

Results

`- Nineteen patients were included in the study with a median age of 26 years (16 - 43) and a BMI of 24 (22-25). The median hospital stay of 14 days (14 - 21) and the median follow-up was 11 months (4 - 13). The median cold ischemia time was 90 mins (70 - 100), estimated blood loss was 500 cc (400 - 500) and operative time was 11 hrs (10 - 12). - A viable phallus was achieved in 13 patients (overall free flap survival 68.4%). - Of the successfully viable phallus cases, 8 cases (42.1%) were complicated by complete disruption of the urethra and the remaining five cases (26.3%) had complete urethral tube. - One case of them developed a fistula at the neo-urethera/native urethral anastomosis, one case had a distal fistula and one case had a ring stricture at the site of anastomosis. - The gracilis muscle flap prevented urethral fistula formation in 4 out of 5 cases (80%) with complete urethral tube.

Conclusions

`- The use of pedicled garcilis muscle flap wrapping around the neo-urethra/native urethral anastomosis during RFFP might be helpful in reducing the urinary fistulae rates at this site. However, larger comparative studies are needed.

Disclosure

No
(522) Possible Role of the Sex Script in the Orgasm Gap Between Genders: How Sodomy is an Egalitarian Practice
Authors: Choucroun D
Published: May 2023

Introduction

The orgasm gap between genders is found in scientific and generalist literature: men, of all sexual orientations, report reaching orgasm during nearly 90% of sexual intercourses, while heterosexual women only achieve orgasm during 65% of intercourse.

Objective

We want to demonstrate that the sexual script of penis/vagina penetration is anatomically less satisfactory than anal penetration, and carries risks for women: unwanted pregnancy, iatrogenic risks of contraception We want to highlight, that in terms of gender, this script is unequal, while during sodomy, role can be exchanged, with the help of a dildo, the man can discover his passivity, and no longuer submit to the erection's performance.

Methods

Literature review: -we introduced the words “orgasm gap” on PubMed for the last five years -press articles

Results

We have found only four survey about the orgasm gender gap on PubMed When the women can't achieve orgasm, they are generally advised clitoral stimulation During the consultation we hear the women say: I do not feel anything during vaginal penetration, indeed the vaginal mucosa is weakly innervated, and vagina does not have sphincters, which decreases the sensation after childbirth. Conversely the anal region and the rectal mucosa are strongly innervated.

Conclusions

Sodomy requires learning as sport or music. This learning can cause unpleasant sensations, but when the technique is acquired, as for sport or music, the pleasure is deep intense and continuous. We do not stop sport or music because of aches and pains of the beginner. Sodomy is egalitarian, that can be practiced by all genders, bringing intense pleasure, too often reserved for initiates, and therefore we can say that sodomy is sacred, leaving to the laymen the few orgasmic tremors obtained painfully by external stimulation of the penis or the clitoris.

Disclosure

No