bluuebunny/crossref_metadata_2025 huggingface dataset:
46 Intracavernous Injection of Botulinum Toxin may Improve Erectile Function in a Bilateral Cavernous Nerve Injury Animal Model
Authors: Campbell J , Feng K , De Young L , Brock G
Published: April 2022

Introduction

Erectile dysfunction (ED) is common after treatments for prostate cancer, such as radical prostatectomy (RP) and can negatively impact both patient and partner quality of life. Botulinum toxin (Botox) promotes smooth muscle relaxation and may augment erectile function by reducing basal sympathetic tone in the corpora cavernosa. Botox utilization has suggested a neuroprotective and nerve regenerative role after peripheral nerve injury.

Objective

We investigated Botox as a durable treatment option for ED in a bilateral cavernous nerve injury (BCNI) animal model. We evaluated the structural changes in penile smooth muscle after intracavernous injection of Botox in an animal model of post-RP ED.

Methods

Sixteen Sprague Dawley rats (4.5months; 450-550g) were randomized to 4 groups: (1) Sham + NS (2) BCNI + NS (3) Sham + Botox (4) BCNI + Botox. When cavernous nerves were identified during surgery, they were either crushed (BCNI) or left untouched (Sham). Next, either 10 units of Botox or 80umL of normal saline (NS) were injected into the corpora cavernosa. On day 14, erectile function was assessed via cavernous nerve electro-stimulation induced intracavernous pressure (ICP) changes. Penile tissue was harvested for immunohistochemistry and Western blot for neuronal nitric oxide synthase (nNOS) and smooth muscle α-actin (SMA).

Results

Fourteen animals were included for analysis; one animal in groups 2 and 3 were euthanized for weight loss and lethargy. The Botox treatment groups had a net weight loss whereas the NS groups had weight gain (p<0.05). Erectile function after BCNI recovered with Botox injections and both group 3 & 4 had mean peak ICP and area under the curve values analogous to baseline (group 1) and statistically improved compared to control (group 2) (Figure 1). Western blot analysis revealed a recovery of both nNOS and SMA after Botox treatment (P=0.06).

Conclusions

This is the first animal study evaluating intracavernous Botox injections for treating ED after BCNI and compared to placebo, the intervention appears to recover erectile function. Further preclinical studies are needed to support this finding, but there may be a future role for using Botox to treat post-prostatectomy ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: boston scientific
61 Penile Extra-Tunical Graft Reconstruction of Peyronie's Disease Concavity Deformities
Authors: Diao L , Badkhshan S , VanDyke M , Lewis Z , Dropkin B , Joice G , Sanders S , Hudak S , Morey A
Published: April 2022

Introduction

The extra-tunical grafting (ETG) procedure was recently introduced by UCSF investigators as a tunica-sparing technique for management of penile concavity deformities.

Objective

We report our initial experience with the ETG procedure.

Methods

We retrospectively reviewed clinical records of patients who underwent ETG at our tertiary-care referral center between 2017-2020. A collagen graft made from bovine pericardium (Lyoplant®) was placed overlying the defect without violating the tunica albuginea or mobilizing the neurovascular bundle. The stretched penile length (SPL) and circumference at the location of deformity were measured intra-operatively. Patient reported outcomes including overall satisfaction, graft palpability, and change in erectile function were evaluated by an anonymous ten-question online survey.

Results

Nineteen men underwent ETG during the study period and had a median follow-up of 59 (IQR: 24 - 708) days. ETG was performed via either a window (15/19, 78.9%) or a de-gloving (4/19, 21.1%) incision with concomitant penile plication performed in 16/19 (84.2%) patients. Penile circumference increased by an average of 1.37 cm ± 0.53 (p = 0.03) at the location of deformity; pre- and post-operative SPL were similar (14.0 ± 1.4 vs. 14.0 ± 1.3 cm, p = 0.95). Fifteen patients (78.9%) responded to the online survey at an average of 240 days after surgery. Overall patient satisfaction was reported by 13/15 (86.7%) patients. Twelve out of 15 (80%) patients reported concavity deformity to be improved, with 73.3% reporting the deformity to be “much better” (Figure). One patient (5.3%) reported penile hypoesthesia/decrease in sensation. An improvement in erectile function was reported in 11/15 (73.3%) patients. Two of 15 (13.3%) patients noted no change in erectile function and 2/15 (13.3%) reported a decrease in erectile function. Of the 8 patients that had follow up greater than six months after surgery, graft palpability was reported in 4/8 (50%) patients but was not bothersome.

Conclusions

The ETG procedure appears to be safe and effective for the treatment of penile concavity deformities. Patient outcomes and satisfaction are favorable at intermediate follow-up.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
63 Evaluating Different Low-intensity Extracorporeal Shockwave Therapy Intensities in the Treatment of Peyronie's Disease in a Rat Model
Authors: Kim J , Soubra A , Kim H , Greenberg J , Ottaiano N , Morenas R , Chacko B , Wisen W , Fatima N , Dick B , Halat S , Almajed W , Raheem O , Abdel-Mageed A , Hellstrom W
Published: April 2022

Introduction

Low-intensity extracorporeal shockwave therapy (Li-ESWT) is postulated to have physiologic effects including neo-angiogenesis, upregulation of vasoactive endothelial growth factors, nerve recovery, reduction of fibrotic changes, cavernosal tissue remodeling, and reduction in sympathetic tone. To date, randomized clinical trials have failed to demonstrate a change in penile curvature, with mixed results on erectile function, in Peyronie's disease (PD) patients.

Objective

To evaluate the treatment effect of Li-ESWT for amelioration of PD-associated fibrosis and PD-associated erectile dysfunction using a rat model of PD.

Methods

32 adult male Sprague-Dawley rats were divided evenly into four groups: sham (S), control (T), low setting Li-ESWT (TL), and high setting Li-ESWT (TH). Normal saline was injected into the tunica albuginea (TA) of the sham group. Transforming growth factor beta-1 (TGF-B1) was injected into the TA of the remaining groups to induce Peyronies-like fibrosis. After 5 weeks of TGF-B1 induction, treatment with Li-ESWT shockwave (UroGold 100™) was initiated. Treatment was delivered biweekly for 3 weeks (6 total sessions). Device settings were 600 shocks at 3 Hz, at level 6 (0.093 mJ/mm2) for the Low group and at level 12 (0.125 mJ/mm2) for the High group. Two weeks after the end of treatment, erectile function was measured by ratio of intracavernosal pressure (ICP) to mean arterial pressure (MAP). Histological analysis by H&E and Trichrome staining was performed. Western blot analysis of Collagens I (COL1A1), III (COL3A1), elastin, alpha-smooth muscle actin (a-SMA), and TGF-B1 was performed.

Results

There was no significant difference demonstrated in erectile function between T control group and TL and TH groups (P > 0.05). However, there seems to be a trend in decreased amount of fibrosis upon examination of the prepared histologic sections. Animals in the TL and TH groups had decreased COL1A1, COL3A1, elastin, and TGF-B1 expression in the TA compared to the T group. a-SMA expression in the treatment groups was found to be increased compared to both S and T groups.

Conclusions

Our preliminary data shows that Li-ESWT treatments, at different intensities, may decrease fibrosis induced by TGF-B1 TA injections. Additionally, Li-ESWT was not found to have conclusive positive effects on erectile function.

Disclosure

Yes, this is sponsored by industry/sponsor: Sexual Medicine Society of North America

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
68 Incidence of Secondary Intervention for Peyronie's Disease after Collagenase Clostridium Histolyticum
Authors: Nackeeran S , Masterson T
Published: April 2022

Introduction

Collagenase clostridium histolyticum (CCH) is the only FDA-approved medical therapy for Peyronie's Disease (PD). It is unknown how many men will elect for surgical correction after CCH treatment. Other surgical options exist, including penile plication, incision and grafting and penile prosthesis. By studying patients within the Veterans Health Administration (VHA), who are all insured and therefore not limited by cost, we aimed to determine the percentage of patients electing additional surgical correction after treatment with CCH.

Objective

To determine the need for secondary surgical correction after CCH

Methods

We queried the VA Informatics and Computing Infrastructure (VINCI), the VHA's national database, to identify veterans with a diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We searched medication codes for CCH and surgical CPT codes to determine which patients had the following procedures PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). Patients with medication codes for CCH and another procedure were assumed to have had surgery after CCH.

Results

In total, 17,647 veterans were diagnosed with PD. Of those, 1295 (7.3%) were treated with CCH. Of those who were treated with CCH, 100 (7.7%) elected for intervention after CCH. Within the group 61 had penile prosthesis, 23 had penile plication, and 32 had plaque excision and grafting (16 combined with IPP).

Conclusions

Approximately 7% veterans who are treated with CCH injection elect secondary surgical correction. This indicates that CCH is an efficacious option for men suffering from PD, and a particularly beneficial choice for those who do not want surgery.

Disclosure

No
71 Adult Patient's Opinions on Surgical Correction of Congenital Penile Curvature
Authors: Ziegelmann M , Winkelman A , Holler J , Breyer B , Herndon A , Villanueva C , Kern N
Published: April 2022

Introduction

Congenital penile curvature is common and presents with varying levels of severity. The curvature may present during infancy or post-pubertal. Historically, treatment has consisted of surgical correction, typically with penile plication or complex grafting procedures. Most pediatric urologists recommend surgical management for penile curvature (PC) based on curvature severity, with previous work identifying ≥ 30° as a common threshold to recommend correction.

Objective

To assess adult patients’ opinions on willingness to consider surgical correction for PC in order to determine if this aligns with pediatric urologists’ opinions.

Methods

In this cross-sectional study, a survey was administered to adult patients and their partners (> 18 years of age) in general adult urology clinics at 3 geographically separate institutions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected for themselves or their partners. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction (p-values < .05 considered significant).

Results

Response rate was 77% (300/388). The majority (80%) of participants chose to surgically correct PC, however 20% chose to not surgically correct any degree of PC. Most participants were male (70%), married (62%), heterosexual (92%), and did not work in healthcare (80%) (Table 1). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 40.5° (SD 25.3). On univariable analysis, there was a significant difference in willingness to undergo PC correction based on gender, age groups, sexual orientation, and region (Table 1). Male patients were more likely to consider surgery at a lower degree of PC compared to females (36.6° vs 50.6°, p<.001). Those who identified as heterosexual also had a lower threshold for correction compared to those identifying as LGBTQ (39.6° vs 56.4°, p=.015). Midwestern residents endorsed an average threshold for correction of 21.5° compared to other regions varying between 40° to 60° (p<.001). Regionality differences remained true on multivariable analysis when accounting for all demographic features (p<.001).

Conclusions

In surveying adult patients, we identified an average PC threshold of 40° beyond which surgical correction was desired. Females and LGBTQ+ participants had a higher threshold for surgical correction, but when accounting for all demographic factors, only residence in the Midwest US was associated with a lower threshold for correction.

Disclosure

No
94 Anabolic-Androgenic Steroid Use is Associated with Major Depressive Disorder and Suicide Attempt: Analysis of a Multi-National Database
Authors: Nackeeran S , Patel M , Nallakumar D , Deibert C , Ramasamy R
Published: April 2022

Introduction

Anabolic-androgenic steroids (AAS), synthetic derivatives of the male sex hormone testosterone, are often used to enhance athletic performance and physical appearance. Long term use of AAS can be associated with mood destabilizing effects and psychotic behavior. We hypothesized that AAS use is an independent risk factor for mental health disorders. We investigated AAS use and associations with major depressive disorder (MDD), suicide attempt (SA)/intentional self-harm (ISH), and body dysmorphic disorder (BDD) by querying TriNetX, a global health research network that provides data on large cohort of patients from multiple centers across the United States.

Objective

To determine the association between AAS use with MDD, SA/ISH, and BDD.

Methods

To evaluate the psychiatric risk of AAS use two cohorts of adult men, aged 18-50, without history of gender dysphoria (F64, Z87.890) (1) history of documented AAS use, inclusive of testosterone prescriptions (2) history of a visit to a healthcare organization and no history of AAS use. We accounted for confounding variables known to be associated with a risk of mood disorders through propensity score matching by logistic regression for age, race, ethnicity, male hypogonadism (E29.1), history of nicotine dependence (Z87.891), or alcohol-related disorder (F10). We evaluated the association between steroid use and subsequent diagnosis of MDD (F32-33), SA/ISH (T14.91, X71-83, T36-65 and T71 ISH codes), or BDD (F45.22) as a primary outcome through regression analysis with statistical significance assessed at p<.05.

Results

We identified 159,717 cis-men between age 18-50 who used AAS and following propensity score matching for confounding variables, we compared them to an equal-sized cohort of men without AAS use. AAS use was independently associated with all of the psychiatric outcomes that we studied (MDD OR 2.96 95% CI 2.88-3.04 p<.0001, SA/ISH OR 1.37 95% CI 1.25-1.50 p<.0001, BDD OR 5.37 95% CI 2.82-10.21 p<.0001). Strengths of the study include a large sample size, propensity score matching to adjust for confounding variables, and high strength of association. Limitations include lack of information regarding indication for steroid prescription or details regarding severity, duration, withdrawal, or possible steroid abuse.

Conclusions

AAS use appears to be an independent risk factor for MDD, BDD, and/or SA/ISH. Future studies are necessary to elucidate whether a dose-response association exists, withdrawal from AAS plays a role, and if patient selection or preventative measures can mitigate the risk. Men with suicide attempt, BDD, or MDD should be investigated for a history of AAS use. Further, men receiving AAS should be counseled on the possible risk of developing MDD in the future. AAS use can lead to profound and complex psychiatric complications which should be discussed in patient counseling.

Disclosure

No
161 300 Patient Experience with Same Day Surgery for Artificial Urinary Sphincter Insertion - A Safe and Efficient Option
Authors: Dropkin B. , Sanders S. , Kavoussi M. , Shaaban A. , Joice G. , Hudak S. , Lotan Y. , Morey A.
Published: April 2022

Introduction

Prior research has questioned the need for overnight observation (OBS) following artificial urinary sphincter (AUS) surgery.

Objective

We sought to analyze our institutional experience transitioning from OBS to same day surgery (SDS) for AUS surgery.

Methods

We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 03/2020. Medical records were reviewed for patient demographics, immediate postoperative complications, timing of postoperative discharge, need for readmission, emergency department (ED) visit, outpatient phone call, or non-routine clinic visit within 7 days of discharge, and need for device explant or revision within 90 days of discharge. Patients were grouped based on discharge status: OBS vs. SDS. Catheters were removed prior to discharge (OBS group) or self-removed at home (SDS group) on the morning of postoperative day 1 (POD1). Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients (09/2017 through 08/2020). Student's t and Chi-squared tests were used to compare groups.

Results

We identified 528 men who met inclusion criteria. Men in the SDS group (n = 308) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier (Table). Men in the OBS group (n = 220) were more likely to suffer an immediate postoperative complication and to be readmitted within 90 days of surgery. The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs. none for SDS patients (n = 183).

Conclusions

SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
165 IPP Cylinder Extrusion. Our Experience and Approach
Authors: Habashy E. , Kohler T.
Published: April 2022

Introduction

The inflatable penile prosthesis (IPP) is a widely accepted surgical treatment for refractory ED. It has the highest satisfaction rates of all ED treatment modalities; however, 7-8% of patients will require reoperations. Mechanical failure, infection, erosion, and extrusion are some of the common indications for reoperations.

Objective

Our video highlights our IPP revision approach that is aimed to lower the risk of future cylinder extrusion/displacement. We also share a rare case of a retained rear tip during device explanation.

Methods

Our video demonstrates our standard technique of obtaining corporal exposure, performing distal corporotomies to explant the cylinders, and utilizing long-acting sutures to prevent future device extrusion. We also demonstrate an encounter with a retained rear tip and our management approach in that scenario.

Results

Our video successfully demonstrates our intraoperative techniques and surgical approach during IPP revision procedures. It also highlights our experience with postoperative cylinder extrusion from 2017-2021.

Conclusions

Our surgical approach during IPP revision using distal corporotomies and long-acting absorbable sutures for corporotomy closure aims to reduce the risk of potential cylinder extrusion. The technique was developed based on our own experience with this complication.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Dr. Kohler is a consultant for Coloplast
166 CT Cavernosography Technique
Authors: Trussler J. , McCullough A.
Published: April 2022

Introduction

Penile anatomy is complex and variable, and not readily assessed with standard ultrasound techniques. Herein we describe the technique and performance of CT cavernosography for the evaluation of penile anatomy in complex cases of Peyronie's disease and erectile dysfunction.

Objective

To describe the procedural steps of CT cavernosography, along with a case report of its use.

Methods

An injection of vasoactive medication is given intracavernosally. A 1cc injection of subcutaneous 1% lidocaine is administered for local analgesia. A 20 gauge angiocatheter is inserted into the corpus cavernosum. 5cc of contrast media is injected via the cannula while the intracavernosal injection takes effect. After 5 minutes, a volume of contrast is injected via the angiocatheter such as to induce a maximal rigidity erection. A CT scan is then obtained. Finally, 2000mcg of phenylephrine is injected via the cannula, and the catheter is removed. A compressive dressing is applied. Images are available for review with the patient within 15 to 20 minutes.

Results

The procedure is well tolerated and provides valuable insight for both the patient and physician with regards to future treatments for Peyronie's disease and erectile dysfunction.

Conclusions

CT cavernosography can be performed easily and readily by the urologist for complex patients who desire further investigation of their condition, or to delineate further anatomic detail prior to undertaking a surgical procedure.

Disclosure

No
204 Growth Factor Concentration Can Vary in Platelet-Rich Plasma from Men with Erectile Dysfunction
Authors: Khodamoradi K , Dullea A , Golan R , Molina Leyba M , Masterson T , Arora H , Ramasamy R
Published: April 2022

Introduction

Erectile Dysfunction (ED) affects 40% of men over 40 and every decade after increases the likelihood by 10% (1). Platelet Rich Plasma (PRP) is a restorative therapy rich in cytokines and growth factors that may reverse the underlying pathology of ED (2). Before PRP can be used effectively in clinic, it is necessary to understand if its components are similar among men with ED.

Objective

To determine whether growth factors vary among PRP of men with ED

Methods

Blood was obtained from three men with ED and one healthy man as a control. The Arthrex Angel system was used to extract their PRP. The sample was immediately stored in ice and kept in -80 C. Bradford assay was ran to ensure equal protein concentrations were used. The Abcam Human Growth Factor Antibody Array kit (ab134002) was used to simultaneously detect 41 human growth factors.

Results

Subject 1 was 43 years old with ED only. Subject 2 was 43 years old with obstructive sleep apnea, hyperlipidemia, and delayed sleep phase syndrome, and BMI 27.1. Subject 3 was 49 years old with hypertension, diabetes mellitus (not on insulin), asthma, high cholesterol, and BMI 32.4.The results of evaluating the 41 growth factor array showed that several growth factors had a fold change greater than 1.5 compared to the control. In PRP of adults with ED, PDGF-AA, PDGF- AB, and PDGF-AB had a greater than 1.5-fold change in at least 2 out of the 3 samples when compared to control. In FGF-6, GM-CSF, NT-3, TGF-α, TGF-β, and TGF-β2, there was a negative fold change of greater than 1.5 in at least 2 out of the 3 samples when compared to control.

Conclusions

Based on these results, the use of PRP as a therapeutic agent may need to be personalized based on individuals' age, comorbidities, or growth factor content. Individuals with underlying comorbidities may need different volumes of PRP. Our future ongoing research is focusing on particular growth factors within PRP that are responsible for improvement in erectile function, thus being able to personalize PRP therapy for me with ED. Citations: 1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. 2. Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells. 2020;9(5). 3. Fang J, Huang X, Han X, Zheng Z, Hu C, Chen T, et al. Endothelial progenitor cells promote viability and nerve regenerative ability of mesenchymal stem cells through PDGF-BB/PDGFR-beta signaling. Aging (Albany NY). 2020;12(1):106-21.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceutical
206 Unexpected Therapeutic Responses in Sexual Function in Women Prescribed Flibanserin for Hypoactive Sexual Desire Disorder
Authors: Goldstein I , Patel S , Donatucci S , Faragasso A , Tojino S
Published: April 2022

Introduction

Flibanserin is a multifunctional serotonin agonist and antagonist for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD). Flibanserin is approved for use in premenopausal women in the US and in both premenopausal and postmenopausal women ≤60 years old in Canada. A post-hoc analysis of Female Sexual Function Index (FSFI) scores from pivotal trials in premenopausal women with HSDD indicated significant improvements in total and individual domain scores after treatment initiation with flibanserin compared to placebo.

Objective

The purpose of this case report study is to examine the postmarketing database to determine whether improvements in other aspects of sexual function have also been reported by women who were prescribed flibanserin in real world use outside of clinical trials.

Methods

A search was performed in the global safety database to identify postmarketing case reports from August 2015 to March 2021. “Therapeutic response unexpected” was the Medical Dictionary for Regulatory Affairs (MedDRA 23.1) preferred term used in this search strategy. Study results include only case reports with narratives containing verbatim terms relevant to the domains on the FSFI (arousal, lubrication, orgasm, pain, satisfaction), excluding desire as this is an expected response.

Results

Thirty-two postmarketing case reports, including 13 patient testimonials of “therapeutic response unexpected”, were identified during this period. Of these 32 case reports, 12 (38%) contained terms related to unexpected improvements in sexual function. Among the 12 reports of improved sexual function, 10 (83%) included terms related to increases in frequency, intensity, or duration of orgasms, one of which also mentioned improvement in arousal. The remaining 2 cases included 1 report of improvement in lubrication and 1 report of improvement in pain.

Conclusions

These postmarketing case reports are consistent with the post-hoc analyses of the data from the flibanserin clinical trials and provide further support that flibanserin therapy can lead to improvement in multiple aspects of sexual function in addition to sexual desire.

Disclosure

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

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals
212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications
Authors: Wu S , Swanton A , Gross M
Published: April 2022

Introduction

Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. Registered Nurse First Assistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant.

Objective

Comparing the influence of different assistants on perioperative complications of Inflatable Penile Prosthesis

Methods

Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. A logistic regression model was used to identify predictors of complications. Student's T test was used to examine for differences in total OR time between different assistants.

Results

A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 – 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs 72.9 ± 35.5 min, p<0.01). Patient factors including new IPP, BMI>30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 – 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively.

Conclusions

Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
233 “Dipping Time” for Irrisept Solution on Titan Inflatable Penile Prosthesis Hydrophilic Coating: No Difference From 1 to 60 minutes
Authors: Karpman E , Klous D , Zhang W , Taylor J , Henry G
Published: April 2022

Introduction

Since hydrophilic coated penile prostheses (PP) first came out, people have discussed how long should the PP be submerged in whatever solution the surgeon decided to “dip” the implant into hoping for the solution to absorb onto the coating of the PP. There has been much discussion and several studies on different antimicrobial agents to soak the Titan PP into. Irrisept is FDA approved to irrigate surgical wounds and company statements appear to show that 99.9% of bacteria and fungus are covered by the solution.

Objective

For the first time in the known literature, we evaluate dipping time of the hydrophilic coating of the Titan PP.

Methods

The Titan PP was soaked in Irrisept solution or normal saline for 1, 15, 30 and 60 minutes. All parts were placed in a 35°C oven for 15 minutes to dry before Congo Red Dye test. Congo Red Dye testing was performed per test method VV-0199713, which is the approved FDA test for ensuring product reliability. The testing was done by an independent third company.

Results

There was no noticeable effect or difference of coating adherence between different soaking times for Irrisept solution or normal saline. Pre-connected IPP products including both pumps and cylinders were tested. (Figure 1 Congo Red stain)

Conclusions

There appears to be no difference in soaking time from 1, 15, 30 or 60 minutes for Irrisept solution or normal saline. Biocompatibility and long-term device performance have not been verified using the Irrisept solution.

Disclosure

Yes, this is sponsored by industry/sponsor: Coloplast

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
235 Penile Invagination and Corporal Excavation for Penile Prosthesis Placement in Severe Corporal Fibrosis
Authors: Kim C , Campbell S , Allkanjari A , Barton G , Lentz A
Published: April 2022

Introduction

The penile prosthesis is a standard treatment for men with erectile dysfunction refractory to vacuum, medical, or injection therapies. In patients with virgin tissue planes and normal anatomy, prosthesis placement can be technically straight forward and associated with minimal morbidity. Patients with corporal fibrosis present a unique surgical challenge for implantation and there is no standardized approach to care. Selection of the appropriate surgical technique can vary depending on the extent of corporal fibrosis and surgeon experience. In this case, our patient's corporal fibrosis resulted from two episodes of prolonged priapism as well as two distal shunts and a failed attempt at inflatable penile prosthesis placement resulting in a prolonged wound infection.

Objective

We present our unique surgical approach for penile prosthesis implantation in the most severe cases of corporal fibrosis.

Methods

Video demonstration of corporal excavation and penile prosthesis placement via a perineal incision with complete penile invagination.

Results

Comprehensive pre-operative planning guided our decision to utilize a malleable prosthesis given the severe degree of corporal fibrosis and higher risk of complications with a three-piece IPP. Our penile invagination technique allowed us to achieve complete longitudinal corporal exposure while avoiding multiple incisions or overlapping incisions near the corporotomy and cylinders. Tachosil or other biologic grafts should be available for use in cases where primary corporotomy closure is not possible.

Conclusions

We demonstrated that penile invagination, corporal excavation, and implantation with a malleable prosthesis is a safe and effective treatment for patients with the most severe corporal fibrosis.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific
239 The Tunneling Technique: A Universal Approach for Salvage Penile Prosthetic Implantation in Severely Scarred Corporal Bodies
Authors: Osmonov D , Ragheb A , Junemann K , Wilson S
Published: April 2022

Introduction

IPP implantation in severe cases of intracorporal scarring poses a daunting challenge, even to experts in the field, owing to associated difficulty and high rates of complications.

Objective

In a step-by-step video, we demonstrate the successful implantation of an IPP in a case of total intracorporal fibrosis utilizing the tunneling technique through the subcoronal approach. We aspire this video to serve as an instructive resource for treating these special cases.

Methods

We present our approach performed on a 32 year old African male patient suffering complete intracorporal fibrosis as a result of a full week episode of ischemic priapism due to sickle cell anemia. The penile shaft was degloved via a subcoronal incision. In addition to the conventional instruments required for IPP implantation, for tunneling and dilation, we used the Wilson's backward cutting scissors, the Uramix original cavernotomes (http://www.uramix.com/category/og/), the Carrion-Rossello cavernotomes (https://www.coloplast.co.uk/rossello-en-gb.aspx), and the Zephyr cavernotomes. Apart from the unique corporal dilation steps, IPP implantation was performed in the classic fashion. A closed suction drain was utilized as part of our routine protocol. Our patient was followed up the patient for one month on a weekly basis then again after 3 months.

Results

After successful corporal tunneling utilizing our special instruments we were able to seamlessly implant a size 20 Coloplast Narrow-Base Titan Touch prosthesis with 2 cm rear tips on both sides. The patient demonstrated an eventless postoperative follow-up period for up to 3 months and was highly satisfied with his implant.

Conclusions

We believe that corporal tunneling via the subcoronal approach may be both a successful and universal option for cases of severe intracorporal fibrosis provided both adequate surgeon experience and special instruments were available. It is a minimally invasive approach excluding the need for corporal reconstruction and utilization of additional grafting thus lowering the risk of postimplantation infection.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
245 Penuma® Concealed Surgery Technique Featuring A New Scrotal Incision
Authors: Elist J , Wilson S , Tajkarimi K , Levine L , Valenzuela R , Blick S
Published: April 2022

Introduction

Innovation in surgical techniques can lead to enhanced patient outcomes and increased efficiency. Penuma®, a silicone penile sleeve implant used for cosmetic enhancement of the penis, has traditionally been inserted through an infrapubic incision. Recently, a new scrotal incision method for silicone penile sleeve implantation has been developed named the “concealed” technique. Compared to the traditional infrapubic entry point, a longitudinal 1-2 cm incision is made to the left or right lateral base of the penis on the scrotum. Aside from the incision location, the remainder of the procedure mirrors that of the traditional suprapubic technique.

Objective

The purpose of this video is to demonstrate the “concealed” technique with the insertion of the Penuma® implant through a scrotal incision.

Methods

Multiple prosthetic urologists have conducted the Penuma® insertion procedure, employing the “concealed” technique. The technique is demonstrated and narrated in the video. Patients were followed post-operatively for at least three months following the procedure to help identify the benefits of the “concealed” technique versus the traditional infrapubic approach.

Results

Various benefits have been observed using this technique. The first benefit is the lack of a visible incision. After three months of healing, the resultant scar appears hidden by the scrotal rugae giving the appearance that no procedure had taken place. Secondly, the procedure time has been reduced by an average of 10 minutes. Third, there appears to be less retraction of the penis immediately after the procedure. With the traditional suprapubic entry point, the placement of closing sutures may cause scar contraction and tightness leading to temporary retraction in flaccid size immediately after the procedure. Comparatively, the “concealed” method utilizes a scrotal incision line, which allows the suprapubic and abdominal skin to remain not incised, leading to immediate penile skin expansion without the initial, temporary retraction. Finally, post-operatively, the concealed technique has led to a lowered likelihood of seroma formation due to no abdominal wall dissection. This has led to decreased swelling and fluid accumulation. Consequently, this has also led to less reliance on the surgical drain (1-2 days vs. 3-4 days with the tradition technique).

Conclusions

The new scrotal approach named the “concealed” technique appears to be a simpler, quicker, and more aesthetically favorable alternative to the traditional suprapubic approach. The “concealed” technique is especially ideal in cosmetic surgery where peno-centric patients are focused on penile appearance. Physicians employing the use of the scrotal incision seem to agree that there is a lessened chance of seroma formation, simpler post-operative care, and favorable immediate results. Further evaluation must be conducted to identify additional benefits, but the initial benefits appear to be very promising.

Disclosure

No
103 Testicular Microlithiasis Defines a Subgroup of Azoospermic Men with Low Rates of Sperm Retrieval
Authors: Dekalo S , Barda S , Pignanelli M , Campbell J
Published: April 2022

Introduction

Testicular microlithiasis is prevalent in sub-fertile men but data regarding its association with sperm retrieval rates in azoospermic men are lacking.

Objective

To investigate the prevalence of testicular microlithiasis and its relationship with sperm retrieval rates and histopathology in azoospermic men.

Methods

Eighty-six consecutive men underwent scrotal ultrasonography prior to microsurgical testicular sperm extraction (microTESE). Sperm retrieval rate, testicular histopathology, testicular size, reproductive hormone estimation, karyotyping, Y chromosome microdeletion analyses and the presence of varicocele and hydrocele were compared between men with and without testicular microlithiasis.

Results

In total, sperm retrieval rate was 40%. Testicular microlithiasis was detected in 12 men (14%). In this subgroup, sperm retrieval rate was only 8% (1/12) as opposed to 45% (33/74) in azoospermic men with no evidence of microlithiasis (p=0.02). Mean right and left testicular diameters were significantly lower in the microlithiasis group compared to men without microlithiasis (2.4 cm vs. 3.2 cm and 2.4 cm vs. 3.3 cm, respectively, p=0.04). There was no significant difference in any other parameter between the groups (age, FSH levels, prevalence of XXY karyotype, Y chromosome microdeletions, sonographic varicoceles or hydroceles). All eleven patients with microlithiasis and no spermatozoa found were diagnosed with Sertoli cells only on histopathology. The patient with testicular microlithiasis and successful sperm extraction was diagnosed with mixed atrophy.

Conclusions

Among our cohort of azoospermic men who underwent scrotal ultrasound prior to microTESE, the presence of testicular microlithiasis was associated with very low sperm retrieval rates. Larger, prospective studies should be conducted to strengthen our results.

Disclosure

No
106 Premenstrual Dysphoric Disorder on Youtube: a Quality Analysis
Authors: Kyarunts M
Published: April 2022

Introduction

Watching videos on YouTube™ (http://www.youtube.com) to learn about diseases and treatments is becoming more popular.

Objective

This cross-sectional study evaluated the quality of YouTube™ videos on Premenstrual Dysphoric Disorder (PMDD).

Methods

YouTube™ was searched for “premenstrual dysphoric disorder” and the fifty most viewed videos were analyzed. Three quality measures were used: Global Quality Scores, JAMA benchmark, and DISCERN. Other features recorded included video duration, views, likes, dislikes, and subscribers. Spearman correlation was calculated to understand the relationship between quality and those features. Source of upload, target audience, distinction between PMS and PMDD, and inclusion of Diagnostic and Statistical Manual 5 (DSM-5) criteria of PMDD were recorded.

Results

The fifty videos had 2,004,266 views. No statistically significant associations were found between video quality and other features. Mean JAMA, GQS, and DISCERN were 1.96/4 (SD=0.45), 2.26/5 (0.94), and 29.5/80 (8.2), respectively. The majority (48%) of videos described symptoms and treatment. 14% gave DSM-5 for PMDD. The target audience were patients for 82%. The common sources of upload were individual users (34%), professional organizations (16%), healthcare professionals (12%), and academic organizations (10%). 20% mentioned the importance of tracking symptoms in a menstrual diary. 28% distinguished PMDD from Premenstrual Syndrome (PMS). 30% of the videos included personal narratives, 20% included descriptions from medical doctors, and 12% included both.

Conclusions

The overall quality of the videos is poor based on the three measures. Since the quality of videos remains unregulated and they are easily accessible, inaccurate information can be disseminated quickly. The study revealed a need for more objective biopsychosocial information on the diagnosis, clinical presentation, and treatment options on the video platform. Currently, healthcare professionals and academic institutions post only a minority of videos. To increase credible information, healthcare professionals and academic organizations can increase the number and quality of videos they make for YouTube™.

Disclosure

No
110 Acne, Folliculitis and Post-Operative Infection Rates of Penile Prosthetic Implants
Authors: Choi E , Barnard J , Horns J , Paudel N , Das R , Yafi F , Hotaling J
Published: April 2022

Introduction

Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined.

Objective

In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI).

Methods

The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant.

Results

Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b).

Conclusions

There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome