bluuebunny/crossref_metadata_2025 huggingface dataset:
(155) Transcutaneous Electrical Neural Stimulation Improves Overall Satisfaction in Patients with Erectile Dysfunction
Authors: Saffati G , Naeem T , Orozco-Rendon D , Kaaki B , Khera M
Published: February 2024

Introduction

Transcutaneous electrical neural stimulation (TENS) therapy has demonstrated the potential to augment peripheral blood flow towards the musculature, thereby enhancing oxygen supply to the working muscles. Erectile dysfunction (ED) is a pathological condition characterized by compromised blood flow to the penis. In theory, TENS therapy can enhance penile blood circulation and alleviate the symptoms associated with ED.

Objective

Therefore, we aimed to assess the effects of penile TENS therapy on reducing ED symptoms and improving erectile function (EF).

Methods

We conducted a pilot cohort trial following approval from the Institutional Review Board (IRB), in which we enrolled patients presenting with clinical ED at our clinic. The TENS therapy intervention comprised ten sessions lasting 20 min each, administered over a period of 5 weeks. Two TENS patches were used, with one patch positioned at the base of the penis and the second patch placed on the perineum. The intensity of TENS therapy was determined using a scale ranging from 0 to 10, with the patients selecting the maximum intensity that they could tolerate without experiencing pain. Baseline and post-therapy questionnaires were administered using the International Index of Erectile Function (IIEF) as the primary outcome measure. A paired t-test was conducted to assess the results, which are presented as the mean difference (MD) along with a 95% confidence interval.

Results

Ten patients, all of whom were already receiving oral PDE5i medications ED were enrolled. However, specific drugs, dosages, and regimens were not standardized across patients, although they maintained the same treatment regimen throughout the study period. The mean baseline total testosterone level was at 527.9 ng/dL. On average, the intensity of TENS therapy administered to the patients was 6.58. A statistically significant improvement in the IIEF total score was seen with an MD of 5.6 (95% CI:0.35, 10.85; p = 0.03). Additionally, a statistically significant difference was observed in the IIEF overall satisfaction domain, with an MD of 1.20 (95% CI:0.14, 2.26; p = 0.03). However, no significant differences were found in IIEF erectile function, desire, orgasm, and intercourse satisfaction subdomain scores. Furthermore, none of the patients reported any adverse effects associated with TENS therapy.

Conclusions

These findings suggest that TENS therapy has the potential to improve the overall satisfaction of patients with ED. Further research with larger sample sizes and randomized controlled trials are warranted to validate these initial findings and to elucidate the full potential of TENS therapy in ED management.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(160) Improving Symptoms in Young Men with Erectile Dysfunction: Testosterone Therapy With or Without PDE5 Inhibitors
Authors: Song J , Saffati G , Naeem T , Biles B , Pierce H , Lipshultz LI , Khera M
Published: February 2024

Introduction

While erectile dysfunction (ED) in young men has traditionally been viewed as primarily psychogenic in etiology, a growing body of evidence supports a higher prevalence of organic etiology.

Objective

The aim of this study was to further characterize the etiology and treatment outcomes of ED in men under 40 years at a single institution.

Methods

A retrospective chart review of men presenting with ED from 2010-2022 was undertaken. Men initially presenting under the age of 40 years were included and analyzed for hypogonadism, ED etiology, and treatment outcomes.

Results

Of our cohort, a total of 74 men under the age of 40 years presented with complaint of ED (mean age 31.6 years). Twenty-three (31.1%) men were eugonadal without organic etiology of ED. Of these men, 22 (95.7%) were started on phosphodiesterase-5 inhibitors (PDE5i) and one (4.3%) reported symptom resolution without treatment. The remaining 51 (68.9%) men presented with ED of likely organic origin. Forty-two (82.4%) of these men were hypogonadal and were started on testosterone, human chorionic gonadotropin, clomid and/or a PDE5i. Of those who followed up, 32 (91.9%) men reported improvement in symptoms after therapy. The organic etiologies of ED in the nine (17.6%) eugonadal men included history of urologic surgery (4), Peyronie’s disease (2), prior genitourinary trauma (1), spinal cord tumor (1), and prolactinoma (1). Within this group, four (44.4%) progressed to intra-cavernosal injection, two (22.2%) improved with PDE5i, and three (33.3%) were lost to follow-up.

Conclusions

It appears that the majority of young patients who present with ED are hypogonadal. Treating this population of men with medication to raise natural testosterone with or without the addition of a PDE5i has been shown to improve their symptoms. Young eugonadal men with no discernable organic etiology of ED respond well to oral PDE5i alone but tended to not follow-up, suggesting possible ED resolution without a need for prolonged treatment. In all, clinicians should check serum testosterone levels and conduct a thorough urological history to identify potential organic etiologies of ED in younger men before assuming a psychogenic basis.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company
Authors: Vercnocke J , Zhong A , Liaw A , Ginsburg K
Published: February 2024

Introduction

Direct-to-consumer (DTC) mail order pharmacies often entice patients with erectile dysfunction (ED) by highlighting the ability to obtain medication online and avoid an “awkward” doctor’s visit. The markup and cost of obtaining medications for ED through subscription services from DTC pharmacies that include a “telemedicine” visit remains unknown.

Objective

To compare the cost of generic ED medications available from DTC mail order pharmacies to Mark Cuban Cost Plus Drug Company.

Methods

We obtained the cost of medications from three direct-to-consumer online mail order pharmacies (hims, BlueChew, and Roman) as well as comparable medications which are available with a prescription from Mark Cuban Cost Plus Drug Pharmacy. Cost per pill, monthly costs, and annual costs were compared in a variety of subscription options from DTC pharmacies compared with Cost Plus Drug Company.

Results

Introductory packages of sildenafil started at $25/month at BlueChew (30mg, 6 pills/month, $4.17/pill), $26/month at hims (25mg, 4 pills/month, $6.50/pill), and $16/month at Roman (25mg, 4 pills/month, $6.25/pill). Alternatively, 30 pills at Cost Plus Drug Company costs $9.40 (20mg, 30 pills/month, $0.32/pill). Introductory packages of tadalafil started at $25/month at BlueChew (6mg, 4 pills/month, $6.25/pill), $30/month at hims (10mg, 4 pills/month, $7.50/pill)), and $39/month at Roman (5mg, 4 pills/month, $9.75/pill). Alternatively, 30 pills at Cost Plus Drug Company was $10.70 (10mg, 30 pills/month, $0.36/pill). The cheapest per pill price of sildenafil is $2.79 at BlueChew (30mg), $4.00 at hims (25mg), and $2.80 at Roman (25mg). To obtain the lowest price, patients are required to commit to 34 pills/month at $90 from BlueChew, a 12-month subscription for 16 pills/month totaling $768 from hims, and a 12-month subscription of 10 pills/month totaling $336 from Roman. The cheapest cost/pill at Cost Plus Drug Company was $0.15/pill (20mg) to obtain 90 pills for $13.40. These values are even more stark when ordering the highest strength and highest quantity of tadalafil for 1 year from each of DTC pharmacy: BlueChew $1,445 (9mg, 28/month, $4.30/pill), hims $1,284 (10mg, 16/month, $6.69/pill), and Roman $5,136 (20mg, 10/month, $42.80/pill)). 360 tabs of Tadalafil 20mg from Cost Plus Drug Company cost $75.20, $0.21/pill). This analysis is limited as the cost of a doctor’s visit to obtain a prescription is not included in the price of medications at Cost Plus Drug Company but is included in the direct-to-consumer services.

Conclusions

Direct-to-consumer online pharmacies that include a telehealth appointment and provide access to generic medications to treat ED have considerable markup. This markup likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription to treat ED. Prescribers should inform patients of cost-effective methods to obtain commonly used medications to treat ED.

Disclosure

No.
(179) Does Climate Impact IPP Infection Risk? Assessment of Temperature and Dew Point on IPP Infections
Authors: Barham D , Pyrgidis N , Amini E , Hammad M , Miller J , Andrianne R , Sadeghi-Nejad H , Gross K , Hatzicrhistodoulou G , Hotaling J , Hsieh T , Lentz A , Modgil V , Osmonov D , Park SH , Yafi F , Perito P , Simhan J , Van Renterghem K , Gross M
Published: February 2024

Introduction

Variations in climate have been associated with greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome. Although the pathogenic organisms for inflatable penile prosthesis (IPP) infections are commonly skin flora, limited data exists on the impact of climate on IPP infections.

Objective

We sought to evaluate the impact of climate on the pathogenic organisms of IPP infections in a large international, multicenter cohort.

Methods

We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Additionally, we assessed the effect of temperature, dew point, and humidity on the microorganisms involved in implant infections. Infections were classified as Gram positive, Gram negative, or mixed (including a combination of Gram positive, Gram negative, and/or fungi). A univariate logistic regression analysis was undertaken.

Results

A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. A total of 103 (1.9%) infections were recorded. Overall, 38 (36.9%) infections were caused by Gram positive bacteria. An increase in temperature was associated with a higher risk of infection with Gram positive bacteria (OR: 1.03, 95% CI: 1 to 1.07, p=0.035). Infections were more frequent as temperature increased with 74.7% of infections occurring when mean ambient temperature was greater than 55□F. No statistically significant differences were recorded in terms of season (p=0.19) and month (p=0.29).

Conclusions

Higher temperature is associated with greater risk of Gram positive infections These findings may help surgeons tailor antibiotic prophylaxis based on local climate especially when temperatures are over 55□F. Our findings should prompt further studies regarding the impact of climate on infection prevention to further improve IPP outcomes.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: consultant Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, Acerus Pharma, Boston Scientific.
(183) Radial Artery Free Flap Urethroplasty
Authors: Sun H , An C , Mishra K , Khouri J , Gupta S
Published: February 2024

Introduction

Urethroplasty is an essential component of gender-affirming phalloplasty for transgender individuals who desire the ability to stand to void through a neophallus.

Objective

We demonstrate the creation of a neourethra using a radial artery free flap for transmasculine individuals with an existing neophallus using live surgical footage.

Methods

The patient was a 36 year old transmasculine individual who had undergone abdominal phalloplasty 6 months prior, and desired the ability to stand to void. Two teams may simultaneously work; one will harvest a radial forearm flap from the non-dominant upper extremity following a preoperative Allen's test. The flap is tubularized over a catheter. The other team will open the existing neophallus and groin site to prepare the flap recipient site. Following microvascular anastomosis, a micro-Doppler is used to confirm perfusion. The donor site is covered with a skin graft and negative pressure wound dressing.

Results

The patient had an uneventful recovery after 48 hours of bedrest with head of bed maintained at 30 degrees, and scheduled flap checks. They were discharged on postoperative day 5 after removal of the negative pressure forearm dressing. He has recovered well and has satisfactory orthotopic voiding on follow-up visits.

Conclusions

This technique of radial artery flap urethroplasty is a safe and effective option for patients who desire a neourethra with their neophallus.

Disclosure

No.
(184) Gender-Affirming Abdominal Phalloplasty
Authors: Sun H , An C , Mishra K , Khouri J , Gupta S
Published: February 2024

Introduction

Phalloplasty can alleviate gender dysphoria in transgender individuals. Various techniques exist and selection of phalloplasty technique depends on patient preference, body habitus, and surgeon experience.

Objective

We demonstrate the creation of a neophallus using a pedicled abdominal flap using live surgical footage.

Methods

The patient was a 19 year old transmasculine individual who had been on gender-affirming hormone therapy for 3 years and desired a neophallus to align external appearance with his gender identity. The flap is designed using a fasciocutaneous flap based off the inferior epigastric and superficial circumflex iliac vessels, with innervation from the ilioinguinal nerve. Perfusion is assessed using fluorescence imaging prior to tubularization. Rotational flaps are used to cover the abdominal wound.

Results

The patient had an uneventful recovery after 48 hours of bedrest and was discharged on post-operative day 4 without complications. He has recovered well without any complications at 6 months postoperatively. Patients may elect to undergo next staged phalloplasty procedures with or without urethroplasty at least 6 months afterwards.

Conclusions

A pedicled abdominal flap phalloplasty is a safe and effective option for patients desiring a more easily concealed scar and fewer complications compared to alternative techniques.

Disclosure

No.
(185) Trans Obturator Repositioning Sling (TOROS); Novel Proximal Fixation of Penile Prosthesis Cylinder in Neophallus
Authors: Kocjancic E , Pathuri M , Barreto PV , Raheem O
Published: February 2024

Introduction

The placement of Penile Prosthesis (PP) in transgender men with a neophallus is technically demanding and poses challenges specifically related to the extracorporal proximal anchoring of the cylinders owing to the lack of proximal corpora. We herein designed a novel Trans-Obtutrator Repositioning Sling (TOROS) for the proximal PP cylinder anchoring in a phallus of cisgender man or a neophallus of transgender man.

Objective

To assess the safety and efficacy of this novel surgical approach for the extracorporal proximal PP cylinder anchoring (TOROS) in two patients (cisgender and transgender) through refashioned use of the AdVanceTM Male Sling System (Boston Scientific). We herein present one video (first patient) to demonstrate step by step surgical technique.

Methods

Two patients were included. First patient is a 38-year-old cisgender male with a history of micropenis who underwent anterolateral thigh phalloplasty in 2017 presents for PP insertion. Second patient is 35 year old transgender with history of right free flap forearm phalloplasty 2019 with prior failed PP revision presents with perineal pain at level of proximal PP cylinder. Both patients consented and elected to proceed.

Results

After careful identification of neophallus vascular pedicle with handheld doppler, a perineal midline incision was made. The space within the neophallus was carefully dissected, dilated up to 11mm with Hegar dilator and measured for upcoming PP cylinder. Next and similar AdVance Male Sling surgical approach, the Adductor Longus tendon identified as a landmark, a trocar was inserted carefully through the obturator foramen around the inferior ischiopubic ramus. The sling was pulled via perineal incision and refashioned into socket-like sling to house the proximal end of PP cylinder or Rear Tip Extender (RTE) (in this case). To further reinforce this connection, sling flanges wrapped around and suture fixated. Next a single-cylinder Ambicor PP (Boston Sci) is inserted. PP pump placed into the left perineal side. Total PP length was 15cm+2cm RTE. PP appeared cycling well. Skin closed in layers. Patient had an uneventful post-op course and discharged on POD #3. At the 6-week mark, the patient had no post-op complaints or complications. The patient has been able to cycle the penile implant twice daily without issue and satisfied with the outcome of the procedure.

Conclusions

Extra-corporal anchoring of PP cylinders using TOROS is a novel, feasible and potentially changing approach in cisgender or transgender men. Proximal anchoring of the cylinders on the inferior pubic ramus and ramus of the ischium through the modified and refashioned use of trans-obturator male sling mimic natural anatomical attachment of the proximal corpora, and the same approach can applied in a transgender man neophallus with apparent good stability with and without axial loading.

Disclosure

No.
(186) Modified Extra-Tunical Grafting for Peyronie's Disease Associated Indentation Deformity
Authors: Kemble J , Helo S , Kohler T , Ziegelmann M
Published: February 2024

Introduction

Peyronie’s disease is characterized by penile plaque or scar within the tunica albuginea. This results in penile deformity, most commonly penile curvature but also volume loss deformity such as hourglass or indentation. This volume loss occurs in up to 65% of men with Peyroine’s disease. Surgical management for patients with significant deformity includes plaque incision/partial excision and penile grafting with an absorbable grafting material. In the original description of extra-tunical grafting, the grafting material was placed over Buck’s fascia via a ventral longitudinal incision. In our modified technique, the grafting material is placed under Buck’s fascia and superficial to the tunica albuginea, which allows the grafting material to be less palpable in the flaccid condition.

Objective

To demonstrate a modified approach to Extra-Tunical Grafting for peyronie’s disease indentation deformity.

Methods

Intra-operative video of modified extra-tunical grafting was recorded with an overhead surgical camera.

Results

Successful modified extra-tunical grafting with excellent penile straightening and restoration of penile girth and minimal palpability of the graft.

Conclusions

Our modified extra-tunical grafting technique is a reasonable option compared to the standard grafting technique

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(187) The SAPOC Technique: Slices Around Point of Maximal Curvature at Time of IPP placement in Severe Peyronie's Disease
Authors: Clavell J
Published: February 2024

Introduction

Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease and erectile dysfunction (ED). Most cases involving plaque incision and graft placement are performed at the point of maximal curvature which result in a large defect that requires placement of a large graft while postoperative penile shortening remains a significant concern among patients.

Objective

To present a video of a novel modification of the multiple slit technique (MUST) for the treatment of severe PD and ED during IPP placement. This technique involves multiple relaxing incisions made around the point of maximal curvature (POMC) which minimizes the size or even the need of a graft while allowing for length restoration.

Methods

This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the POMC is identified, 2 to 4 transverse relaxing incisions (slices) are made around the POMC approximately 1 to 1.5cm apart in order to minimize the size of the defect and hence the need or size of the graft. Each slice allows for maximal restoration of length.

Results

The SAPOC technique results in correction of curvature and length restoration.

Conclusions

The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex PD and ED. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Boston Scientific and Coloplast.
(188) Horizontal Plication and Reduction Corporoplasty for Penile Girth Discrepancy (Christmas Tree Deformity)
Authors: Burns R , Egert M , Soyster M , Alabd A , Bernie H
Published: February 2024

Introduction

We present a case of severe Peyronie's Disease, described as the “Christmas tree deformity” due to its crescendo shaped proximal girth discrepancy. This very rare deformity and proposed surgical correction technique have only been described in the literature once beforehand.

Objective

To depict the surgical correction of the severe penile girth discrepancy in video format.

Methods

At the start of the case, artificial erection was performed, revealing significant girth discrepancy. The proximal base of the shaft measured 21.5 cm, mid shaft 18.5 cm, and distal shaft 12 cm (Image 1). A circumcising incision was made and a plane along Buck’s fascia developed. Using careful blunt and sharp dissection, left and right neurovascular bundles were carefully elevated and gently lifted to the midline to allow for plication suture placement laterally. An artificial erection was again created, revealing significant asymmetry with 9.5cm girth discrepancy between proximal and distal shaft. Plication sutures of 1-0 Ethibond were placed using a “1+1=2” dot horizontal plication pattern, starting at the base and progressing to mid shaft on both the left and right sides. Plication sutures were placed systematically until symmetric girth was confirmed using artificial erection. A TachoSil graft was then placed along the shaft to decrease likelihood patient would feel the numerous Ethibond sutures below and also improve hemostasis. Dartos fascia was then closed with a Vicryl suture and the circumcising incision closed in a running subcuticular fashion. Again, artificial erection showed drastic improvement in penile girth magnitude and symmetry. A penile block was performed and the penis was wrapped in Kerlix gauze and coban.

Results

The patient was discharged on the same-day of surgery with oral pain medications. He was seen back in follow-up at 8 weeks postoperatively at which time he endorsed an uneventful recovery and that he was once again able to have penetrative intercourse with his partner.

Conclusions

We are proud to report on the second known case of horizontal plication and reduction corporoplasty for correction of severe penile girth discrepancy, “Christmas tree deformity.” Despite a lack of available literature on the deformity and surgical technique, we believe it is a safe and effective treatment option for patients with this rare form of Peyronie's.

Disclosure

No.
(189) Modified Mini-jupette Sling for Climacturia During IPP Placement
Authors: Kemble J , Olive E , Byrne E , Warner J , Helo S , Ziegelmann M , Kohler T
Published: February 2024

Introduction

Climacturia, the inadvertent leak of urine during orgasm, is a well-known complication following radical prostatectomy and can cause significant patient/partner bother. The Mini-Jupette sling treats climacturia during placement of an inflatable penile prosthesis (IPP) but requires an extended corporotomy with a complex closure. Our modified Mini-Jupette technique utilizes a standard corporotomy and places the sling inferior as opposed to integrated into the corporotomy. Additionally, we perform an intraoperative drip test for urethral occlusion, which eliminates the need for guessing on sling tension. Corset sutures can then be utilized intraoperatively or in future revision surgeries in the event of sling loosening or recurrent climacturia.

Objective

To visually demonstrate the modified mini-jupette technique and intraoperative drip test.

Methods

An IPP surgical candidate with climacturia was identified. Intraoperative video of the Mini-Jupette technique was recorded using an overhead camera. The Mini-Jupette sling is placed with four vertical Ethibond (00) sutures placed inferior to the corporotomy stay sutures. The drip test is set up by retracting the catheter to the distal urethra and connecting it to a bedside irrigation system set 60cm above the patient. Stoppage of fluid flow during IPP inflation indicates that the sling is appropriately occluding the urethra.

Results

Successful demonstration of a modified Mini-Jupette technique and intraoperative drip test without complications.

Conclusions

Our modified Mini-Jupette and intraoperative drip test provide a reasonable alternative to the standard Mini-Jupette technique.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(192) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique
Authors: Kalidoss S , Barreto Guimaraes P , Nusbaum D , Raheem O , Kocjancic E
Published: February 2024

Introduction

Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease.

Objective

We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient.

Methods

A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4-0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3-0 Vycril suture.

Results

This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature.

Conclusions

Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease.

Disclosure

No.
(193) Bilateral Onco-TESE and Placement of Bilateral Testicular Prostheses
Authors: Massari M , Krishingner A , Campbell K
Published: February 2024

Introduction

Here we present the case of a 36-year-old male who underwent bilateral Onco-TESE (oncologic testicular sperm extraction) and insertion of bilateral testicular prostheses in the setting of bilateral testicular masses and refractor testicular pain. Preoperative evaluation revealed the presence of non-obstructive azoospermia and Klinefelter syndrome.

Objective

To demonstrate the effectiveness and feasibility of bilateral Onco-TESE as a therapeutic option for the patient with bilateral testicular masses, refractory bilateral testicular pain, non-obstructive azoospermia, and Klinefelter syndrome while attempting to preserve future fertility.

Methods

A comprehensive diagnostic workup was performed preoperatively including physical examination, scrotal ultrasound, hormonal evaluation, semen analysis, and genetic testing. Informed consent for the procedure and its filming was obtained from the patient prior to undergoing bilateral Onco-TESE and insertion of bilateral testicular prostheses.

Results

Pathologic analysis of testicular masses revealed Multinodular Leydig cell hyperplasia. The extracted testicular tissue yielded no viable sperm. The patient’s testicular pain resolved after the immediate postoperative period with an excellent cosmetic result.

Conclusions

This case presentation highlights a unique indication for bilateral Onco-TESE and insertion of bilateral testicular prostheses in a patient with bilateral testicular masses, bilateral testicular pain, Klinefelter syndrome, and desired future fertility.

Disclosure

No.
(194) Midline Reservoir Placement of Infrapubic Inflatable Penile Prosthesis: A Step-by-Step Surgical Technique
Authors: Kalidoss S , Suarez-Sarmiento A , Raheem O , Perito P
Published: February 2024

Introduction

Various alternative placements of inflatable penile prosthesis (IPP) reservoirs have been previously documented, differing from the traditional retroperitoneal placement in the Space of Retzius. Pelvic trauma, history of surgery in the pelvic region, and atypical anatomy can necessitate an alternative location for implantation of the IPP reservoir. The midline placement of the IPP reservoir provides numerous advantages in outcomes, patient experience, and versatility of implantation. This video demonstrates the surgical procedure for midline placement of the IPP reservoir.

Objective

We outline a surgical technique to place the IPP reservoir in an alternative midline location.

Methods

The patient was instructed to void his bladder prior to the procedure to circumvent Foley catheter insertion. A 2.5 cm-wide horizontal incision was made 2 finger widths cranially to the dorsal aspect of the base of the penis. The surgeon’s index finger was used for blunt dissection along the linea alba above the pubic tubercles. A tonsil clamp is used to pierce the rectus fascia at the midline, below the arcuate line, to leave a defect just wide enough to accommodate a 70 mm nasal speculum. The surgeon’s finger is used to assess the space to determine if a 9/10 mm Hegar dilator is necessary to expand the avascular space by sweeping it parallel to the fascia. The speculum is inserted and positioned with the blades pointed cranially parallel to the facial axis and the handles pointed superiorly. The reservoir is prepared and delivered into this space using a metal pediatric Yankauer suction tip through the open blades of the nasal speculum. A syringe filled with saline solution is connected to the reservoir tubing, and the fluid is transferred completely to the reservoir and the tubing is clamped. The tubes originating from the reservoir and implant cylinders are both clamped, trimmed to length, and connected to each other in a watertight fashion to permit the bidirectional flow of saline solution. Proper IPP cylinder inflation is tested prior to closing the incision.

Results

The reservoir is thus safely deployed cranially to the pubic bone and avoids interfering with the urinary bladder. No complications were observed in this patient, and he was discharged on the same day.

Conclusions

The midline surgical placement of the reservoir during the infrapubic implantation of an inflatable penile prosthesis is a safe and effective alternative placement for patients with prior pelvic surgery, injuries, or atypical pelvic anatomy. Patients with compromised pelvic, abdominal, or inguinal regions due to hernia repair, patulous inguinal rings, or dense lateral pelvic scarring stand to benefit the most from this reservoir placement. This procedure outlines the surgical steps of midline reservoir placement for new IPP implantation or relocation during a revision procedure.

Disclosure

No.
(207) Ejaculatory Function After Benign Prostatic Hyperplasia (BPH) in Gay and Bisexual Men
Authors: Prabhu R , Li E , Panken E , Greenberg D , Amarasekera C
Published: February 2024

Introduction

Retrograde ejaculation (RE) is a common outcome of surgical treatments for benign prostatic hyperplasia (BPH). Previous qualitative work in the context of prostate cancer has shown that gay and bisexual men (GBM) experience greater bother from loss of ejaculatory function. Ideally, BPH treatment decision-making for GBM who prioritize ejaculatory function would take into consideration their specific needs and outcomes. However, there is no quantitative or prospective data on BPH outcomes in GBM men to inform their care.

Objective

Our objective was to analyze the characteristics of BPH patients in a urology clinic catered to the needs of GBM in order to fill the gaps in knowledge of BPH outcomes in GBM and improve care.

Methods

We performed a retrospective review of all GBM patients presenting to an LGBT specialized urology clinic between 9/1/2021 and 4/30/2023. Patients who underwent a procedure for BPH with at least one recorded AUA symptom score were included.

Results

24 gay and bisexual BPH patients presenting to the clinic between 9/29/2021 and 4/25/2023 were included. Ages ranged from 32 to 82, with a mean age of 64.23 (SD = 11.43, n=24). The distribution of treatments offered was TURP (n=14), Rezum (n=4) and TUIP (n=1). Of the TURP procedures, 10 were ejaculatory sparing. Four patients received two forms of treatment. Of the 16 patients asked, 14 said ejaculatory sparing mattered to them (Mean age = 67.03, SD = 6.28) and 2 said it did not (Mean age = 77.63, SD = 10.57). The average pre-treatment AUA-Symptom Score for the patients was 20.85 (SD = 6.89, n=13) and average QoL was 4.00 (SD = 1.13, n=12). The average post-treatment AUA symptom score for patients was 8.50 (SD = 5.21, n=8), and average QoL was 1.38 (SD = 1.41, n=8).

Conclusions

A vast majority of the clinic’s GBM patients place importance on ejaculatory function. Younger GBM placed greater importance on ejaculatory function compared to older men. AUA symptom scores on average were on the low end of severe pre-treatment, with patients feeling mostly dissatisfied with urinary function. Post treatment AUA symptom scores varied but were centered around the low end of moderate, with patients feeling mostly pleased with urinary function. These initial findings from our clinic highlight the need for further prospective research on GBM patient values and outcomes surrounding ejaculatory function.

Disclosure

No.
(238) Changing Landscape of Erectile Dysfunction: Shift in Risk Factors and Presentation Patterns
Authors: Naeem T , Saffati G , Chaput MB , Iacobucci A , Green C , Lipshultz LI , Khera M
Published: February 2024

Introduction

Roughly 52% of men over the age of 40 have ED. However, our understanding of ED risk factors is constantly evolving.

Objective

The aim of this study is to provide a contemporary update of risk factors and characteristics of men presenting with erectile dysfunction (ED).

Methods

A retrospective review identified 576 men presenting to our tertiary academic center between 2009 and 2022 with the chief complaint of ED. Their medical charts were reviewed and analyzed for demographic information and treatment outcomes.

Results

The mean age of the cohort was 64.3 years (S.D. = 15) with initial testosterone levels of 310.5 (IQR = 231.8-437.2). The median symptom duration at presentation was 2 (IQR = 1-5) years, but more than half had already tried PDE5i therapy in the past (260/452, 57.5%, 95% CI (52.8-62.1%)). Men in the cohort had higher than national rates of hypertension (35.6%, 95% CI = 31.3-40.1%) and hyperlipidemia (30.5%, 95% CI = 26.4-34.0%) but the percentage of patients with diabetes was on par with national rates (14.7%, 95% CI = 11.6-18.2%). Men with Peyronie’s disease constituted 14.6% (95% CI = 11.5-18.2%) of the cohort (66/453) and 23 of those men had a radical prostatectomy (4.6%). Over half of the patients (310/576, 53.8%, 95% CI = 42.2-65.2%) were started on PDE5i oral therapy, of whom 61% (189/310) of men were satisfied with the effect.

Conclusions

Patients with ED are known to be more likely to have comorbid chronic conditions such as hypertension, diabetes, and dyslipidemia. Prior studies have demonstrated that in men presenting with ED, 42% had hypertension, 20% had diabetes, and 42% had hyperlipidemia. However, our study reveals a lower rate of these risk factors than previously shown. In our study, men were waiting approximately 2 years before they sought treatment, which is 2 years earlier than prior literature. Finally, over half of the men had previously used a PDE5i upon presentation, which suggests that many men are presenting with more advanced ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(245) Surveying the Genomic Landscape of Peyronie's Disease: A Study of 22 Cases
Authors: Machado B , Oliveira A
Published: February 2024

Introduction

Since its description in 1743 by François de la Peyronie, penile fibromatosis continues to present an elusive pathogenesis. One of its distinguishing characteristics is the excessive proliferation of fibrogenic myofibroblasts, resulting in the formation of dense fibrous plaques that disrupt the normal cytoarchitecture of the tunica albuginea, giving rise to penile abnormalities. The possible clonal nature of the disease has been investigated by many studies and some have identified occasional karyotypic abnormalities, most commonly involving chromosomes 7, 8, 17, 18, X and Y (Mulhal JP et al 2004).

Objective

This study aimed to comprehensively analyze the genomic landscape of Peyronie's disease in a significant number of cases using a whole genome copy number variation assay (CNV). The objective was to identify any recurrent chromosomal gains or losses that could shed light on the pathogenesis of this disease, including the potential identification of an underlying clonal process.

Methods

Thirty-nine surgical specimens were retrospectively examined from men diagnosed with Peyronie's disease, collected between 1992 and 2022 (median age: 56 years, range: 17-73). The study was conducted under the approval of the Institutional Review Board (IRB # 22-006924). Tissue samples were fixed in 10% buffered formalin, embedded in paraffin, and subsequently subjected to histologic review and DNA analysis. DNA extraction followed standard protocols. Among the samples, 22 contained high-quality material suitable for CNV array analysis using the OncoScan SNV array, which encompassed approximately 900 genes/loci with a resolution of 50-125 kb. Additionally, the array included a somatic mutation panel targeting nine cancer-related genes.

Results

No significant loss or gain of chromosomal material was identified in the twenty-two cases analyzed. However, the somatic mutation panel revealed potential unconfirmed DNA mutations in NRAS, EGFR, and TP53. Ongoing studies are being conducted to confirm these mutations.

Conclusions

The etiology and pathogenesis of Peyronie's disease remain unresolved, presenting a challenging area of research. However, the findings of this study provide evidence that major recurrent losses or gains of chromosomal material are unlikely to play a significant role in the pathogenesis of this disease. While shedding light on this aspect, it is crucial to acknowledge that further research is necessary to confirm and expand upon these initial observations.

Disclosure

No.
(272) Botulinum Toxin Injection in Vulva and Vagina: Evidence from a Literature Systematic Review
Authors: Benalla A
Published: February 2024

Introduction

Vaginismus, vulvodynia and chronic pelvic pain are a group of pain syndromes that may have, in addition to pain, other types of symptoms. Often no specific etiology can be identified, and the choice of treatment is complicated. Although several treatment methods have been proposed, evidence-based therapies are limited. Therapies can be classified in medical, surgical and interventional treatment. Interventional therapy contemplates injection therapy with botulinum toxin, proposed in 1997

Objective

To evaluate the BoNT injection in the comprehensive care of vaginismus, vulvodynia and chronic pelvic pain and to enhance the impact on the sexual arousal.

Methods

1108 patients, Randomized Controlled Trials (RCT) were 7. The Retrospective Studies Without a control group were 4, With a control group: 1. Besides, the Prospective Studies Without a control group were, . 2 patients were With a control group. The BoNT Dosage Range was: Minimum: 12 UI Maximum: 500 UI Types of BoNT Products: Botox® (onabotulinumtoxinA): 14 Xeomin® (incobotulinumtoxinA): 3 Dysport® (abobotulinumtoxinA): 3 Unspecified BoNT Product: 1 EMG-Guided Injection: 5 I used as BoNT Administration Techniques, the Digital Palpation: 12, the unspecified Injection Procedure: 4. My methods were 17 patients in Intramuscular Injection, 3 patients with Vaginal Submucosal Plane, and one patient with Subcutaneous Injection.

Results

For Vaginismus, Significant improvement in sexual and orgasmic dysfunction Successful intercourse Reduction of vaginal muscle resistance Improved sexual function (evaluated by Female Sexual Function Index) Pain reduction and improved quality of life (Short-Form Health Survey) BoNT reduced muscular hyperactivity. Both BoNT and placebo improved sexual pain, function, and distress for patients with vulvodynia, Significant improvement in pain 4, improved quality of life 2 and increase of sexual activity due to the reduced pelvic hypertonicity. Other Study Results: Significant improvement in pelvic pain [22, 23, 31, 32] Reduction of vaginal pressure [32] Improvement in quality of life, sexual activity, and reduced pelvic floor muscles myoelectrical activity [31]

Conclusions

Different endpoints and different methods of analysis. Different types of participants. Various techniques and timing. Adverse events. For this reason, even though BoNT seems a promising treatment, a clear standardization in clinical guidelines is still lacking. A clear standardization is needed for practical guidelines. Future perspectives should address reproducible protocols for BoNT administration.

Disclosure

No.
(286) Gender Disparities Exist in the Surgical Management of Peyronie's Disease and Urologic Prosthetics: An Evaluation of American Board of Urology (ABU) Surgical Case Logs
Authors: Bui K , Hochberg A , Schneider AC , Chung PH
Published: February 2024

Introduction

Urology has been predominantly male-dominated, although recent trends indicate increased female representation among urology residents, physicians and advanced-practitioner providers. While progress has been made, gender disparities persist due to societal perceptions and biases. The goal of this study was to investigate whether a provider gender gap exists in the field of reconstructive urology using American Board of Urology (ABU) case logs.

Objective

To examine case volume characteristics for provider gender disparities in Peyronie’s disease and urologic prosthetic surgery.

Methods

Retrospective review of surgical case log data from 2003 to 2023 of certified urologists was performed for 11 Current Procedural Terminology (CPT) codes for the surgical management of Peyronie’s disease (penile plication CPT 54360, plaque excision/incision with grafting CPT 54111, 54112), male urethral sling or artificial urinary sphincter (CPT 53440, 53445), and placement of penile implant (CPT 54400, 54401, 54405). Inclusion criteria included male patients who were 18 years old or older. Data collected included patient and surgeon demographics, surgical procedure, and surgeon fellowship training status. Cases were analyzed using descriptive statistics and regression testing.

Results

From 2003 to 2023, a total 2,852 urologists performed 15,171 Peyronie’s disease and urologic prosthetic surgical procedures. Among these procedures, 1,910 (13%) Peyronie’s disease, 8,940 (59%) penile implant, and 4,321 (28%) incontinence procedures were identified. Out of the total practicing urologists, 2,626 were male and 226 were female; the distribution of cases revealed 5 cases performed per male surgeon and 4 cases per female surgeon. Over two decades, there was a significant positive trend in the proportion of cases performed by female surgeons (p < 0.001). 169 (6%) surgeons completed fellowships in Andrology or Male Reconstruction, and performed 2,129 (14%) of total procedures. Across surgeons with Andrology or Male Reconstruction fellowship-training, there were 13 cases performed per male surgeon and 7 cases per female surgeon.

Conclusions

Our study confirms underrepresentation of female surgeons in the field of Peyronie's disease and prosthetic urology. Although there is a trend of increasing female representation over time, further research can be done to identify barriers to gender equality in the field.

Disclosure

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