bluuebunny/crossref_metadata_2025 huggingface dataset:
(019) Malignant Priapism: Case Report and Update on Management Protocols
Authors: Tabei SS , Baas W , Brooks A , Kim EH , Smith Z , Murphy G
Published: February 2024

Introduction

Malignant priapism is a rare condition characterized by persistent erection resulting from the invasion or metastasis of a primary neoplasm. Penile metastases arise from the genitourinary tract 64% of the time (bladder: 28.6%, prostate: 27.9%, kidney: 6.9%, ureter: 0.5%) with colorectal adenocarcinoma, lung cancer, melanoma, and hematologic diseases comprising the remainder. Malignant priapism is reported to occur in 20-53% of patients with penile metastasis. The mechanism of malignant priapism remains unknown. The most accepted theory is an invasion of the corpus cavernosum as well as associated venous systems with malignant cells. This can occur from either hematogenous or lymphatic spread from the source tumor. Resulting derangement of arterial or veno-occlusive mechanism causes priapism. Both ischemic and non-ischemic priapism can occur.

Objective

While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. This study aims to present three cases of malignant priapism resulting from advanced genitourinary cancers and evaluate the efficacy of palliative penectomy as a treatment modality for relieving symptoms associated with malignant priapism.

Methods

We conducted a retrospective analysis of three cases of malignant priapism associated with advanced genitourinary cancers. Data were collected from medical records, including patient demographics, primary tumor characteristics, clinical presentation, treatment modalities, complications, and outcomes. The main treatment approach utilized in all cases was palliative penectomy. Symptom relief and complications were assessed as primary outcomes.

Results

All three patients presented with progressive penile pain, and imaging studies confirmed the presence of metastatic disease involving the penile structures. Palliative penectomy was performed in all cases, resulting in sustained relief of symptoms. No major complications were reported during the surgical procedures. Follow-up assessments showed improved quality of life in terms of pain relief, but all patients died within a short period following penectomy owing to the advanced predisposing malignancy. (figure 1)

Conclusions

Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes, and emphasis should be put on palliative care. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts. (figure 2)

Disclosure

No.
(045) Comparing Bacterial Presence with the Usage of 0.05% Chlorhexidine Gluconate (CHG) Lavage During Urologic Prosthesis Revision Surgery: Update on Results
Authors: Henry G , Stuart A , Tong L , Stuart A , Karpman E
Published: February 2024

Introduction

An Inflatable Penile Prosthesis (IPP) is third line surgical therapy for refractory ED. An IPP uses a fluid-filled reservoir with a pump and valve system to activate inflation and deflation. Although penile implants achieve the highest success rates in ED treatment, the possible presence of bacteria on the device itself or bacteria exposure accumulated during the surgery increases the risk of progression into biofilm or infection. Biofilm complicates the bacteria eradication effort and can ultimately jeopardize the implant. Often, the only way to treat the post-op infection is with implant removal. Currently, many preventative measures, such as different perioperative irrigations, are being studied to reduce the number of penile implant infections. Research has shown that irrigation at the time of both infectious and noninfectious surgery lowers subsequent infection rates. Different solutions like saline, antibiotic, betadine, and hydrogen peroxide solutions have been considered. Recently, orthopedic literature has shown that 0.05% Chlorhexidine Gluconate (CHG) lavage has effectively reduced biofilm in artificial joint procedures.

Objective

The purpose of this study is to determine the effectiveness of CHG lavage on bacterial presence in IPP implant spaces. We hypothesize that CHG will lower bacterial presence after washing out implant spaces at time of replacement for infections and mechanical failure.

Methods

We aimed to investigate a series of patients who underwent revision IPP surgery while utilizing FDA-approved CHG lavage for irrigation and compared the bacterial presence before and after CHG washout. Additionally, Next Generation Sequencing (NGS), a DNA sequencing technology, was used to further identify the pathogens involved.

Results

Between 2021 to 2023, 48 patients underwent IPP revision surgery for either infectious or noninfectious reasons. During the operation, a section of the capsule tissue surrounding the implanted IPP pump was first taken and sent for cultures. NGS studies were also sent out. After the implant removal, all implant spaces were irrigated and washed out with CHG (two 450-mL bottles). A second tissue culture was then obtained post washout. Of the 48 patients, there were 4 positive bacterial cultures before washout and 13 positive NGS results. Results of the post CHG washout cultures were all negative.

Conclusions

It appears that irrigation with 0.05% Chlorhexidine Gluconate solution is an effective antiseptic that can decrease bacterial presence, and hopefully reduce IPP infections.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Microgen Dx, Irrisept.
(058) Detection and Transcriptional Profiling of Mesenchymal Stem Cells in Peyronie’s Plaque Explants
Authors: Garabed LR , Witherspoon L , Soltani R , Robinson M , Roberts M , Hach F , Flannigan R
Published: February 2024

Introduction

The mechanisms behind the pathogenesis of Peyronie’s disease largely remain a mystery. Plaques have largely been thought to be derived from epithelial to mesenchymal transformation of fibroblasts to myofibroblasts.

Objective

We sought to transcriptomically profile explanted cells from Peyronie’s plaques and evaluate their profiles with transforming growth factor B (TGF-B) stimulation.

Methods

Peyronie’s plaque were excised from 3 patients undergoing penile incision and grafting surgery. Cells were explanted from biopsy tissue and propagated. Cells were profiled using single cell RNA sequencing (scRNAseq). These cells were then exposed to TGF-□ to simulate the active phase of Peyronie’s disease, and profiled with scRNAseq at baseline and 24 hours following TGF-□□ stimulation. We used principle component analysis (PCA) to reduce the dimension of data and built the nearest-neighbors graph using PCA weights. We performed clustering over the nearest-neighbor graph and visualized the clusters using UMAP algorithm. Differential gene expression and pathway analyses were performed using the top 50 genes with increased expression between 0- and 24-hour time points. Multi-channel flow cytometry and immunofluorescence were used for mesenchymal stem cell (MSC) phenotypic validation.

Results

Assessment of cell clustering identified profiles of fibroblasts, myofibroblasts, smooth muscle, and mesenchymal stem-like cells. We further confirmed rare presence of mesenchymal stem cells using multi-channel flow cytometry in our cultured cells and plaque biopsies. Differential gene expression of the 50 genes showing the greatest induction showed that genes involved in cellular binding and catalytic activity were most commonly upregulated following introduction of TGF-B.

Conclusions

This analysis provides unique insight into the expression profiles of Peyronie’s plaque cell populations explanted in culture and stimulated via TGF-B to activate myofibroblasts akin to the active phase of Peyronie’s disease. Using the information gained from this single-cell RNA sequencing analysis ongoing efforts can be performed to identify therapeutic targets for active phase Peyronie’s disease.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast; Boston; Teumo Health Technologies.
(072) Comparing Risk of Post-Infection Erectile Dysfunction Following SARS Coronavirus 2 Stratified by Acute and Long COVID, Vasopressor Administration, and Hospitalization Status
Authors: Grutman A , Gilliam K , Maremanda A , Able C , Choi U , Kohn T
Published: February 2024

Introduction

While multiple studies have shown an association between acute COVID-19 infection and subsequent development of erectile dysfunction (ED), no study has yet assessed the risk of developing ED after a diagnosis of long COVID. It is unclear if there is an increased risk of ED in those with long COVID compared to only those diagnosed with acute COVID. In addition, the impact of vasopressor use and hospitalization for an acute COVID infection on ED development is uncertain.

Objective

This study sought to assess the risk of ED in individuals with acute COVID-19 when compared to individuals with long COVID-19, as well as risk of ED following more severe cases requiring vasopressors and hospitalization.

Methods

The TriNetX COVID-19 Research Network was queried from December 1st 2020 through June 2023. We included men aged ≥ 18-years old and analyzed cohorts comparing the following 1) men diagnosed with long COVID-19 (ICD-10: U09) were compared to those that were diagnosed with or had positive test for acute COVID-19 but no diagnosis of long COVID. Men were included if they had at least one outpatient follow-up visit 2 weeks after the initial positive test result and excluded if they received a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or pulmonary hypertension diagnosis at any time. Additional analyses were performed with the same above criteria including men that were and were not hospitalized within 1 month of acute COVID diagnosis and whether men needed vasopressors or not. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). Variables on which propensity scores were matched are detailed in Table 1.

Results

A total of 2839 men were included in each cohort after propensity score matching with an average age of 54.5 +/- 16.7 years and 55.1 +/- 17.1 years in the long and acute COVID cohorts, respectively. Men diagnosed with long COVID-19 were more likely to develop ED or be prescribed PDE5i (3.63%) when compared to men with only acute COVID-19 infections (2.61%) [RR 1.39; 95% CI 1.04, 1.87]. There was no statistically significant increased or decreased risk of developing ED or being prescribed PDE5i for individuals who received vasopressors [RR 0.922; 95% CI 0.774,1.098] or were hospitalized [RR 0.933; 95% CI 0.824,1.056].

Conclusions

We found that long COVID-19 infection was associated with greater risk for ED diagnosis or PDE5i prescriptions when compared with men diagnosed with only an acute COVID-19 infection, while there was no significantly increased risk for individuals requiring vasopressors or hospitalization.

Disclosure

No.
(100) Urinary and Gynecologic Adverse Events Associated with Ssri Use
Authors: Grzyb C , Durrani K , Boyd Md S
Published: February 2024

Introduction

SSRIs are the most prescribed psychiatric drug in the United States, with approximately 40% of patients reporting side effects to their provider (1,2). It is accepted that side effects of SSRIs may include sexual dysfunction, including decreased libido and anorgasmia (3,4). However, the safety of SSRIs on the functions of the genitourinary and reproductive systems in real-world settings remains unclear.

Objective

The aim of this study was to identify urinary and gynecologic adverse events associated with SSRIs using data from the FDA Adverse Events Reporting System (FAERS). Secondarily, we identify variability of adverse events across individual SSRIs.

Methods

A specialized software to analyze adverse events, OpenVigil 2.1, was used to query the FAERS data. We defined 445 search terms related to genitourinary and reproductive system related events. We performed disproportionality analysis to identify associations between search terms and SSRIs as a class, then each SSRI (fluoxetine, sertraline, paroxetine, escitalopram, citalopram). Subgroup analysis was performed to stratify adverse events by age.

Results

Adverse events related to SSRI usage include a variety of genitourinary and reproductive system related side effects, not limited to sexual dysfunction. Gynecologic bleeding, urinary retention, hypersexuality emerged as surprisingly statistically significant signals across females. Statistically significant adverse events related to sexual dysfunction were present up to age 60, with the strongest signals found in the 40-59 years age group. Urinary symptoms were most prevalent in the 0-18 years and over 60 years age group. Of the SSRIs, citalopram had the strongest association with sexual disorders and dysfunction.

Conclusions

In this study, we offer the most granular side effect profile of SSRIs related to the urinary and reproductive systems to date. While the pathophysiology of each adverse event remains unclear, an understanding of potential risks of these drugs is valuable in the management of patients taking SSRIs, particularly in the event of rare side effects that are often not associated with SSRI use. These are important considerations for clinical practice as side effects of SSRIs can impact treatment compliance and patient quality of life. References 1. Cascade EM, Kalali AM, Kennedy SHMF. Real-World Data on SSRI Antidepressant Side Effects. Psychiatry. 2009;16–8. 2. US National Library of Medicine. Mental Health Medications. National Institute of Mental Health. 2022. 3. Segraves RT. Sexual Dysfunction Associated with Antidepressant Therapy. Vol. 34, Urologic Clinics of North America. 2007. p. 575–9. 4. Rosen RCP, Lane RMM, Menza MM. Effects of SSRIs on Sexual Function: A Critical Review. J Clin Pharmacol. 1999;19(1):67–85.

Disclosure

No.
(109) Characterization of Traditional and Household Items Used Globally for Sexual Pleasure Amongst Adults
Authors: Ikedionwu I , Jung DH , Sun J , Pearlman A , Raheem OA
Published: February 2024

Introduction

Sexual health is an important aspect of overall health. Though sex toys are commonly used by people of all genders, little research exists to explore their safety and efficacy when it comes to optimizing pleasure and improving sexual function in various patient populations. Global barriers to use of sex toys, including limited access, legality, and cost, also have important implications on people being able to use these devices. Household devices have been used, likely as they provide more accessible, cost effective means of optimizing pleasure, though no research exists to assess safety and efficacy of such items.

Objective

The purpose of our study is to categorize the demographics, usage, behaviors, and safety concerns of adults who use traditional and household items for sexual pleasure.

Methods

An electronic survey was distributed across several Reddit forums, including r/sex, r/menshealth, and r/womenshealth. People who consented were 18 years of age or older and those who answered “yes” to having used household item(s) for sexual pleasure were invited to participate in the survey. Demographic information was collected about survey respondents. Types of traditional and household tools used for sexual pleasure were also recorded along with degree of satisfaction, cost, and safety concerns for each item used.

Results

Two hundred thirty-four people responded to the survey over a 72 hour period. Seventy-five percent of those who started the survey, completed it. Participants were most commonly from the United States (40%), Canada (7%), and the United Kingdom (5%). Forty-eight percent did not specify their country of residence. Fifty-five percent of respondents were between the ages of 18 and 45, with an almost even split between men (30%), women (36%), and not specified (35%). The most popular traditional sex toys used were vibrators (n=112), dildos (n=90), and anal toys (n=70). Showerheads (n=92), pillows, (n=52), and electric/pulsating toothbrushes (n=50) were the most common household items used for sexual pleasure. The leading safety concerns were cleanliness and hygiene (n=87) followed by allergies and insensitivity (n=50).

Conclusions

The global sex toy market is a multi-billion dollar industry. The sexual medicine literature is expanding to now include the use of sex toys and tools in various patient populations, though much is still unknown, particularly when it comes to the use of household items used for pleasure. Our study suggests that use of traditional and household items for sexual pleasure can be both safe and effective. When considering global barriers to the use of sex toys, understanding the safety and efficacy of household items is critical, as these may expand our armamentarium of tools to offer patients.

Disclosure

No.
(112) Efficacy and Safety of Platelet-Rich Plasma Injections for Peyronie’s Disease: A Randomized Double-Blind Placebo-Controlled Cross-Over Study
Authors: Ledesma B , Molina M , Velasquez D , Ramasamy R
Published: February 2024

Introduction

Peyronie's Disease (PD) is currently treated with intralesional collagenase injection, the only FDA-approved medical therapy. Platelet-derived therapies, such as autologous platelet rich plasma (PRP), have shown potential in tissue regeneration. We are investigating the safety and efficacy of PRP in PD with an ongoing randomized, placebo-controlled, crossover study.

Objective

The objective of this study is to assess the safety and efficacy of autologous platelet-rich plasma (PRP) treatment in Peyronie's Disease (PD) through a randomized, placebo-controlled, crossover trial.

Methods

We analyzed data from an ongoing trial conducted between April 2021 and June 2023. Men with PD (write degrees/dorsal only etc) were randomly assigned to receive two 0.5 ml injections of PRP obtained using an autologous platelet separator (Arthrex Angel, Arthrex Inc.) or placebo directly into the dominant plaque, with a two-week interval between injections. Immediate post-procedure assessments included Visual Analogue Pain Scale, and follow-up evaluations focused on identifying complications. After three months, participants crossed over to the other treatment arm for two additional injections. Goniometer measurement assessments were performed prior to each crossover (NCT04512287). Related Samples Wilcoxon-Signed Rank test was used for dependent repeated groups, the serial measurements of degree of curvature at different time points for each patient within a specific group. Findings at p< 0.05 were considered statistically significant.

Results

The analysis includes data from 29 men who completed all injections and the 6-month follow-up. No minor or major adverse events, such as penile bruising, swelling, edema, allergy, or penile fracture, were reported. Regarding efficacy, we observed a significant reduction in curvature after six months compared to baseline. The pretreatment median curvature was 40.0 (IQR: 15), the median post-treatment curvature 30.0 (IQR: 30) (p=0.014). Furthermore, we did not observe worsening of curvature in subsequent evaluations.

Conclusions

Our findings from our ongoing clinical trial suggest that PRP treatment for Peyronie's Disease is safe, with minimal adverse events reported. The preliminary efficacy data indicates a significant reduction in curvature after 2 injections each of placebo and PRP treatment compared to baseline. Nevertheless, study completion is necessary prior to reporting true efficacy data comparing PRP vs placebo.

Disclosure

No.
(158) Antihypertensive Medications and Erectile Dysfunction: Is this Association Accurate?
Authors: Visingardi J , Paul Feustel P , De EJ , Inouye B , Welliver C
Published: February 2024

Introduction

The association between erectile dysfunction (ED) and antihypertensive medications (AM) has been previously described with varying results in small or single center data sets. Utilizing large post marketing surveillance databases allows one to study drug side effects across patients in a much larger and more diverse sample size.

Objective

Our study sought to investigate AMs and their medication classes to determine the incidence of ED. Our hypothesis was that thiazide diuretics and beta blockers would have significantly higher rates of reported ED than other AM classes due to the classic association with these medications and ED.

Methods

We utilized the US government Medical Expenditure Panel Survey maintained by the Agency for Healthcare Research and Quality to determine the total number of patients on each medication each year. The total number of ED adverse events reported per year per medication was accessed via the Food and Drug Administration’s adverse event reporting database (FAERS). Date ranges were 2013 to 2020. We reviewed all substantive outpatient AMs and compared them to one another as well as across the class with regards to reported ED rates.

Results

We found that a higher incidence of ED adverse events were reported with ramipril and bisoprolol -15 events per 100,000 patients and 34.1 events per 100,000 patients, respectively. Interestingly fewer adverse events (0.4 events per 100,000 patients) were reported for lisinopril. We did recognize differences among AM classes via Kruskal-Wallis analysis however the structure of our study was not able to distinguish which class was different in rates of ED as a result of the large number of drugs included. Reported ED rates increased over the study period with 2020 having the most ED reports. However, most medications reported fewer than 100 adverse events over an 8-year time period with many medications having tens of millions of patients taking them a year.

Conclusions

Higher rates of reported ED were seen with ramipril and bisoprolol and lower rates found with lisinopril than in other AMs. Differences among medication classes were not identified. The infrequent reporting of ED with AMs questions the existing dogma that AMs cause ED and further consideration should be given to the causality of this association.

Disclosure

No.
(165) Assessing Artificial Intelligence Quality in the Evaluation and Treatment of Erectile Dysfunction
Authors: Pathuri M , Marciano O , Barrtero Guimaraes P , Kocjancic E , Raheem O
Published: February 2024

Introduction

Since November 2022, Artificial Intelligence (AI) chatbots have grown in popularity including in urologic conditions. However, their accuracy and quality has not been evaluated systematically. In this study, we sought to assess the accuracy and quality of AI chatbots in the management of Erectile Dysfunction (ED).

Objective

We aim to evaluate the accuracy and quality of open-source language models in fielding common clinical questions pertaining to ED compared to board certified urologists.

Methods

Two AI open-source language models, ChatGPT and Google Bard, were fielded 15 standard questions related to ED some of which included causes, risk factors and treatment options of ED. Two board certified urologists were given the same questions on a standard survey. A third blinded board-certified urologist served as a grader using the AUA guidelines for ED on a Likert scale to assess the accuracy, robustness, and bias of each response. Urologist and AI responses were graded and aggregated using Likert scales.

Results

Overall AI responses were significantly more accurate (p<0.01), robust (p<0.01), and unbiased (p<0.01). Additionally, Google Bard had the highest scores all around followed by ChatGPT. The urologists’ responses were approximately 38% lower compared to the AI responses.

Conclusions

This study suggests that AI responses were superior compared to urologists in the areas of accuracy, robustness, and bias pertaining to the management of ED. Albeit, the chatbots have promising role in urologic conditions including ED, its widespread clinical use and adoption warrants further evaluation in the context of clinical decision making and enhancing patient care.

Disclosure

No.
(170) Satisfaction with Penile Prosthesis Implantation among Patients with Peyronie’s Disease Using a Contemporary Questionnaire
Authors: Leelani N , Hua V , Shumaker A , Bole R , Lundy SD , Bajic P
Published: February 2024

Introduction

The Satisfaction Survey for Inflatable Penile Implants (SSIPI) is a recently validated 16-question survey used to quantitatively measure patient outcomes after penile prosthetic surgery. The survey consists of four subdomain scores representing the appearance, pain, satisfaction, and function of the penile implant. Since its validation, there have been limited studies examining its use in patients with Peyronie’s disease (PD).

Objective

The objective of this study is to explore the use of the SSIPI in men with Peyronie’s Disease and to determine if any factors predict patient-perceived postoperative outcomes.

Methods

Preoperative, intraoperative, and postoperative data for patients with PD undergoing implantation of an inflatable penile prosthesis (IPP) by a single surgeon at a tertiary care institution was retrospectively collected into a secure database. Only those patients with at least one completed SSIPI postoperatively were included in the analysis. For those patients with multiple completed SSIPI’s, only the most recently completed one was used. Linear regression and Fischer’s exact test were used to determine if there were any significant relationships between variables and the SSIPI scores.

Results

There were a total of 44 men with PD who underwent surgery for an IPP. 31 of them were Caucasian, 11 were African-American, and one each were Hispanic and American Indian/Native American. Median time between surgery and completion of the SSIPI at a follow-up visit was 291 days (IQR 107.75-403.50). 35 men received a Coloplast Titan and 9 received an AMS 700 CX. There was no significant difference in the overall SSIPI score and any of the subdomains between men who received different types of implants or between men of different races. All four subdomains were significantly negatively correlated with the residual curvature which was measured intraoperatively after the IPP was implanted and any adjunctive straightening techniques were used (Fig 1a-d). The appearance domain was also significantly negatively correlated with the preoperative total testosterone indicating that men with a lower total testosterone level were more satisfied with the appearance of their penis. (p < 0.05, R2 = 0.32). Interestingly, those men who underwent manual modeling (n=36) had a significantly lower score in the appearance domain (p < 0.05).

Conclusions

Post-operative residual curvature in men with PD undergoing implantation of an IPP is a predictor of satisfaction with the IPP. The role of preoperative testosterone and intraoperative manual modeling in how men with PD perceive the appearance of their penis postoperatively requires further investigation.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.
(174) Use of Penuma® for Correction of Residual Deformity following Previous Treatment of Peyronie’s disease: Case Series
Authors: Desouky E , Elist J , Levine L
Published: February 2024

Introduction

Over the years, numerous treatment approaches have been explored for Peyronie's disease (PD) including non-surgical and surgical options. Nevertheless, the current options are largely insufficient in effectively correcting residual penile deformities after treatment.

Objective

To evaluate the efficacy of utilizing the subcutaneous silicone penile prosthesis (Penuma®) as a treatment modality for correcting residual penile deformity, including curvature and indentation, and providing penile girth enhancement post-PD treatment.

Methods

This is a two center case series of three patients who had previously undergone various treatments for PD. Detailed data about these patients were collected including their demographics, PD characteristics, previous treatments, and outcomes (see table). These patients previously had different treatments including non-surgical i.e. Xiaflex® and/or surgical options i.e. plication procedure. The placement of Penuma® subcutaneous silicone penile prosthesis was performed in a standardized manner across all cases. Follow-up evaluations were conducted to assess the effectiveness of the procedure and any associated complications.

Results

The main findings of the study revealed successful correction of residual penile deformity (curvature, indentation, narrowing) as well as significant improvement in penile girth in all three cases following the placement of the Penuma® subcutaneous silicone penile prosthesis. The procedure resulted in improved sexual function and satisfactory aesthetic outcomes as reported by patients. No major complications were observed during the follow-up period.

Conclusions

Our case series demonstrates the potential effectiveness and benefits of using Penuma® to correct residual penile deformity and to provide penile girth enhancement in patients post-PD treatment. At this time, we would consider offering Penuma® implantation when residual curvature is less than 30 degrees and indentation does not cause any instability or hinge-effect during penetrative sexual activity. Further research and larger case studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: IMD.
(204) National Trends in the Treatment of Fournier’s Gangrene: 2016-2019
Authors: Su I , Marte J , Lee J , Han D , Kurtzman J , Joice G
Published: February 2024

Introduction

Fournier’s gangrene (FG) is a surgical emergency with significant inpatient mortality and long-term morbidity. Population-based databases such as the National Inpatient Sample (NIS) are valuable tools in investigating rare conditions, yet no recent studies have looked at trends and outcomes of FG at a national level. An increasing burden of this disease may be placed on large academic centers due to regional demographics and hospital transfer to these centers for specialized expertise.

Objective

To evaluate national trends in the management of FG to identify predictive factors of in-hospital mortality or inter-hospital transfer.

Methods

All patients hospitalized with FG between 2016-2019 were extracted from the NIS using the International Classification of Diseases (10th Revision) Diagnosis Code N49.3. Stratified cluster sampling was used to create weighted national estimates. The primary combined outcome was the proportion of patients who died during hospitalization or required inter-hospital transfer. Multivariable logistic regression was performed to identify predictors of this outcome.

Results

Between 2016 and 2019, there were an estimated 21,715 inpatients treated for FG in the US. There was an 8.5% increase in the patients treated yearly over the study period. The average age was 45.8 years, the average length of stay was 10.8 days, and the average total charge of hospitalization was $127,140. Overall, 4.3% of patients died during hospitalization and 7.2% were transferred to another short-term hospital facility. The region with the highest prevalence was the South (44.8%) and most admissions were to urban teaching hospitals (72.6%). Significant predictors of the combined outcome of in-hospital mortality or inter-hospital transfer included older age, non-private insurance, and greater Elixhauser Comorbidity Index (p<0.05). Protective factors included medium/high volume hospital, urban setting (vs. rural), Midwest/Southern region (vs. Northeast), and 2nd or 3rd cost tertile (vs. 1st tertile) (p<0.05) [Table].

Conclusions

We highlight an association of poor outcomes from FG with non-private insurance in older adults with more comorbidities. We also noted an increased burden of FG patients at large, urban teaching facilities due to regional demographics and inter-hospital transfer. Further work needs to be done to determine how inter-hospital transfer and potential delays in life-saving surgical debridement affect outcomes in FG.

Disclosure

No.
(206) Novel Observations about Epididymal Cysts Found in a Cohort of Michigan Men
Authors: Dong Y , Arenas M , Cedona K , Armitage S , Liaw A , Steinhardt G
Published: February 2024

Introduction

Epididymal cysts (EC) are an incidental finding on scrotal ultrasounds (SUS), with an anecdotal prevalence from 5-20% with peaks at age 2 and in puberty. A recent survey at a children’s hospital in Michigan found that up to 35% of boys 15 or older had ECs. While adult men often demonstrate EC, comparatively few papers characterize the prevalence of ECs in adults. It is presumed that ECs most commonly develop during their 20s-40s but no clear prevalence by age has been established in the general adult population.

Objective

This present research will investigate within the same geographic region the prevalence of ECs in adult men.

Methods

A retrospective review was conducted for men 18-years-of-age and older who underwent a Michigan hospital-based SUS between 2010 – 2015. Patients without EC and EC patients were compared using two-sample t test, associations between age and presence of ECs were evaluated by chi-square test, and associations between age and TTV were evaluated by one-way ANOVA and Pearson’s correlation coefficient.

Results

357 out of 801 men (44.6%) were found to have sonographic evidence of ECs. When separated into age groups, the prevalence of ECs significantly increased (p=0.041) with increasing age. In men with only ECs, their TTV did not significantly decrease with age (r = 0.06, p=0.684), unlike men without EC (r = 0.18, p=0.028).

Conclusions

This geographic cohort of men have the highest prevalence of ECs reported in the global literature. Two novel observations are that ECs frequency increases with age and TTV is preserved with age in men with ECs. TTV correlates significantly with FSH, LH, testosterone, and sperm health – further investigation should examine how preserved TTV may correlate with these values. Future studies should also examine the link between endocrine disrupting compound exposure and development of ECs.

Disclosure

No.
(213) Assessing Primary Care Physicians Awareness of 5-Alpha Reductase Inhibitors for Men with Benign Prostatic Hyperplasia
Authors: Babar M , Loloi J , Azhar U , Labagnara K , Salami A , Tang K , Robles J , Maria P
Published: February 2024

Introduction

Primary care physicians (PCPs) commonly prescribe 5-alpha-reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia (BPH). 5-ARIs can affect prostate-specific antigen (PSA) kinetics by decreasing PSA levels by approximately half, and therefore delay the early detection of prostate cancer (PCa).

Objective

To determine PCPs’ level of awareness and indications for urology referral in patients treated with 5-ARIs.

Methods

After IRB approval, an anonymous survey was emailed to affiliated PCPs at an academic urban institution. Questions focused on residency graduation year, patient volume, knowledge of 5-ARIs and their effects on PSA, role of 5-ARIs in PCa prevention, and indications for prostate biopsy referral. PCPs were stratified by residency graduation year before or after 2010, or medical specialty of Family Medicine or Internal Medicine. Survey responses were summarized with descriptive statistics and responses between groups (residency graduation year or medical specialty) were compared using Chi-squared test.

Results

A total of 182 PCPs were emailed, of which 30 responded (16.5% response rate). Thirteen PCPs (43.3%) graduated residency before 2010 and 17 (56.7%) after 2010. Sixteen PCPs (53.3%) were Family Medicine physicians and 14 (46.7%) were Internists. The majority of PCPs reported that every 6 months, they saw at least one patient with BPH (96.7%), ordered at least one PSA test (86.7%), and referred at least one patient for a prostate biopsy (56.7%). Forty percent of PCPs were not aware of the suppressive effects of 5-ARIs on PSA, 70.0% would not refer a patient for a prostate biopsy who is taking 5-ARIs and has an elevated corrected PSA, 70.0% were not sure or thought that 5-ARIs may decrease the risk of high-grade PCa, and 43.3% were not sure or thought that 5-ARIs are approved for the prevention of PCa. There were no significant differences in the knowledge of 5-ARIs and their effects on PSA, role of 5-ARIs in PCa prevention, or indications for prostate biopsy referral between PCPs who graduated residency before 2010 and after 2010, or between PCPs who were Family Medicine physicians and Internists (p>0.05 for all).

Conclusions

There is a general lack of awareness amongst PCPs on the knowledge of 5-ARIs and indications for biopsy referral in patients treated with 5-ARIs. An educational opportunity exists to optimize usage of 5-ARIs and avoid delaying PCa detection.

Disclosure

No.
(215) Penuma® Penile Implant Adverse Events in the Manufacturer and User Facility Device Experience (MAUDE) Database
Authors: Martinez Rivera M , West M , Kaplan-Marans E , Lee J , Katlowitz Y , Jivanji D , Khurgin J
Published: February 2024

Introduction

Penuma® is an FDA-approved penile implant intended to increase flaccid penile length and girth for improved cosmesis. It is the only FDA-approved product of its kind, with reportedly thousands of implants since 2004. There is a paucity of data on the adverse events related to this procedure.

Objective

To describe and characterize adverse events related to Penuma® using a national database.

Methods

The Manufacturer and User Facility Device Experience (MAUDE) database, a voluntary-reported database of medical device complications with data since 1991, was queried. The MAUDE adverse event classification system, a validated classification system, was used as a standardized tool to classify adverse events based on severity. All adverse events related to Penuma® were identified and quantified.

Results

42 reports of adverse events related to Penuma® were identified (Figure 1). Of these, 35 patients were reported to undergo device removal most commonly due to infection (n=8) or protrusion (n=8). (Table 1). The most commonly reported adverse event was deformity/disfigurement (n=27), of which 18 cases reported loss of penile length. Other adverse events included: pain (n=16), infection (n=12), decreased sensitivity (n=10), scar tissue (n=9), erectile dysfunction (n=8), seroma (n=7), and erosion (n=6).

Conclusions

To our knowledge, this is the first study to systematically characterize publicly reported adverse events occurring with Penuma® implantation, using the MAUDE database. Further research is warranted to delineate the incidence of adverse events related to Penuma®.

Disclosure

No.
(218) Bladder Outlet Procedures Performed in Patients with a Penile Prosthesis Do Not Increase Device Complication Rates
Authors: Reddy A , Yu B , Saffeti G , Song J , Dai M , Park B , Applewhite J , Khera M
Published: February 2024

Introduction

At present, minimal evidence exists in the literature regarding the management of benign prostatic hyperplasia (BPH) in patients with a penile prosthesis. While it is considered prudent to address BPH prior to penile prosthesis placement, no formal guidelines exist on this topic and in many instances, patients develop lower urinary tract symptoms secondary to BPH after prosthesis placement. Thus, understanding how to safely manage BPH in this patient population is key to optimal outcomes.

Objective

The aim of this study was to understand if patients with a penile prosthesis who subsequently underwent bladder outlet procedures (BOP) had an increased risk of prosthesis complications compared to those patients who underwent BOP prior to their penile prosthesis placement.

Methods

An Institutional Review Board approved retrospective chart review of all penile prosthesis patients with concomitant BPH from 2008-2023 was undertaken. Men who underwent a BOP before and after penile prosthesis placement were identified and separately analyzed for patient demographics, type of outlet procedure performed, type of prosthesis placed, and complications following penile prosthesis surgery. Complications were defined as any device infections, device malfunctions, or the need for any sort of operative interventions including explant. Statistical analysis was then conducted to identify significant differences between these two cohorts.

Results

A total of 424 patients with a history of penile prosthesis and BPH were identified. Of this group, a total of 61 patients were found to have undergone a BOP. Specifically, 28 patients were found to have undergone a BOP following their penile prosthesis placement, and 33 were found to have undergone a BOP prior to their penile prosthesis placement. Amongst the two cohorts, there were no statistically significant differences in age, race, prostate volume, hemoglobin A1c levels, type of outlet procedure performed, and history of hypertension, hyperlipidemia, radiation therapy, or smoking. Importantly, there was no statistically significant difference in complication rates between the two cohorts (P=0.910).

Conclusions

To our knowledge, this study is the largest ever analysis of penile prosthesis patients who underwent bladder outlet procedures. From this data, it seems that patients who undergo BOP after penile prosthesis surgery are not at increased risk for complications compared to those patients who undergo a BOP prior to penile prosthesis surgery. Given that this is a retrospective chart review of a multi-center, high-volume implant practice, further randomized controlled trials will be necessary to confirm these findings.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie.
(222) Simultaneous Inflatable Penile Prosthesis and Adjustable Male Sling: A Step-by-Step Surgical Technique
Authors: Velasquez DA , Barreto Guimaraes PV , Kocjancic E , Raheem O
Published: February 2024

Introduction

Erectile dysfunction (ED) and urinary incontinence (UI) are common complications following radical prostatectomy (1). At twenty-four months post-surgery, approximately 43% of men experience some degree of ED, while UI affects around 15% of patients between twelve to twenty-four months (2, 3). Notably, nearly 20% of patients experience both ED and UI complications (4). Initial conservative management strategies include the use of PDE-5 inhibitors, intercavernosal injections, or a vacuum erectile device for ED and pelvic floor muscle training for UI (5). However, symptoms that persist or worsen beyond six months can be considered for surgical intervention (6). Surgical options include penile prosthesis implantation for ED and diverse techniques such as the Artificial Urinary Sphincter (AUS) or adjustable male urethral sling, depending on symptom severity, for UI management. Limited evidence suggests that a simultaneous surgical approach addressing both conditions can be a cost-effective and a safe alternative to separate surgeries (7, 8).

Objective

In this context, the objective of this video presentation is to illustrate a detailed, step-by-step technique for the simultaneous implantation of an inflatable penile prosthesis (IPP) and an adjustable male sling (AMS), while also discussing its feasibility, safety, and functional outcomes.

Methods

The combined IPP and AMS surgery is a safe, viable, and cost-effective option for patients who need to address both ED and UI. Rhee (2005) initially described the concurrent placement of a penile prosthesis (PP) and male sling (MS) in a series of four post-prostatectomy patients.

Results

The results demonstrated successful restoration of erections and complete continence in all patients, with no postoperative complications. Our previous systematic review, comparing the outcomes of simultaneous surgical placement of PP and MS versus PP and artificial urethral sphincter (AUS), found no clinically significant differences in outcomes between the two groups (Raheem 2021). Therefore, the simultaneous placement of IPP and AMS should be considered an option for patients, as it shows comparable effectiveness to other concurrent surgical interventions. Dual implantation of PP and male sling have also demonstrated cost savings of approximately $9,000 for patients, further enhancing its advantages in managing both ED and UI (Gorbatiy 2010). Ultimately, a collaborative discussion between patients and their urologist is crucial in determining the most suitable approach for patient individual needs.

Conclusions

The simultaneous surgical placement of an inflatable penile prosthesis (IPP) and adjustable male sling (AMS) presents a favorable and viable solution for managing erectile dysfunction (ED) and urinary incontinence (UI) in patients who exhibit an inadequate response to conservative management following prostatectomy.

Disclosure

No.
(225) Hard-flaccid Syndrome: A Survey of Sexual Medicine Practitioners’ Knowledge and Experience
Authors: Gryzinski G , Moukhtar Hammad M , Alzweri L , Azad B , Barham D , Lumbiganon S , Serefoglu EC , Yafi F
Published: February 2024

Introduction

Hard-flaccid syndrome (HFS) is a condition of male sexual dysfunction (MSD) that has become a relatively new focus in online forums and urologic conferences. It is a poorly understood syndrome characterized by chronic pain, a partially rigid penis while in a flaccid state, and erectile dysfunction. HFS primarily affects men in their second and third decade of life, but its exact pathophysiology remains uncertain, with hypotheses suggesting a combination of physical and psychological factors. Consequently, an evidence-based understanding of HFS is lacking within the sexual medicine community.

Objective

Identify and quantify the current level of understanding of HFS in the sexual medicine academic society.

Methods

A survey was provided to sexual medicine practitioners at the 2023 American Urological Association (AUA) who attended a plenary focusing on sexual medicine. Each survey form included a screening question to determine familiarity with HFS. If they were familiar with HFS, there were multiple additional questions querying experience with HFS in their patients, modalities of diagnosis, preferred therapy options, in addition to others. These answers were then extracted onto a spreadsheet and analyzed.

Results

According to the registration reports from the 2023 AUA conference, there were 37 attendees at the sexual medicine plenary. A total of 36 survey responses were submitted. Of these, 35 were urologists and 1 responder was a mental health professional. Among the respondents, 8 (35%) acquired knowledge about HFS through colleagues, 6 (26%) mentioned medical journals, 4 (17%) mentioned conferences, 4 (17%) mentioned patients, and 1 (5%) stated that they first heard about it from an online pelvic floor therapist. Regarding the diagnostic approach for HFS in their practice, 17 responders considered clinical history, 16 relied on patient self-diagnosis, and 1 utilized imaging, although the specific imaging modality was not specified. Most respondents (74%) indicated that they had seen 1-10 patients with HFS, with 4 and 2 respondents reporting 11-20 and 21-50 patients, respectively. In terms of their beliefs about HFS as a legitimate condition, 12 responders expressed confidence in its existence, while 7 remained uncertain. Most respondents (11) suggested pelvic floor therapy as the optimal approach, with 10 recommending combination therapy.

Conclusions

This analysis highlights the ongoing lack of familiarity with HFS among professionals. This project provides valuable insights into the current understanding of this complex condition. The outcome emphasizes the critical need for continued education and research on HFS to improve diagnostic accuracy, enhance patient care, and develop effective treatment strategies.

Disclosure

No.