bluuebunny/crossref_metadata_2025 huggingface dataset:
(310) Nationwide Priapism Emergency Department Encounters in the United States
Authors: Marte J , Brown W , Ha A , Kerr P , Joice G
Published: May 2023

Introduction

There is a lack of understanding of recent trends and costs in emergency department visits and inpatient admissions for priapism. In particular no studies have evaluated nationwide trends in priapism since the roll out of ICD-10CM coding in 2015.

Objective

To determine contemporary national estimates for emergency department visits and inpatient admissions for priapism in the United States from 2016-2019.

Methods

Emergency department (ED) encounters for priapism were analyzed using the Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP). Patients presenting to the ED with a diagnosis of priapism were identified by ICD-10-CM codes. Patient demographics, hospital characteristics, patient disposition, and costs were evaluated for each visit. Statistical analysis was performed using established weighting provided by the HCUP to create national estimates. Comparisons of demographics were performed using t-tests and chi-square tests with a p-value for significance <0.05. Prolonged length of stay was defined as over two days.

Results

Between 2016-2019, there was a weighted total of 78,993 ED visits for priapism nationwide out of an estimated 576,544,259 ED encounters making up 0.014% (p<0.01) of all ED encounters. The average age of a patient diagnosed with priapism was 41 (SEM=0.102). Patients diagnosed with unspecified priapism made up 73.67% (58,197) of encounters, while those diagnosed with drug-induced priapism accounted for 14.34% (11,325) of encounters, and 7.26% (5,738) encounters of priapism were due to disease. The South region had the greatest number of priapism encounters each year accounting for 46.59% (36,800) of all ED visits mostly in metropolitan teaching hospitals hosted 70.53% (55,713). Inpatient admissions occurred in 16.07% (12,696) of ED visits for priapism. Of those admitted, 79.10% (10,043) had a prolonged length of stay with those staying only a day making up 16% (2,031). Inpatient admissions averaged a total charge of $72,668 compared with $3,763 (p<.0001) for patients not admitted. Of the expected primary payers, private insurance covered 32.14% (25,356) of ED visits for priapism with Medicaid covering 30.24% (23,857), Medicare covering 17.50% (13,805), and self-payers covering 14.77% (11,648).

Conclusions

ED visits for priapism remain a frequent and costly event in the United States Healthcare System. Patients requiring inpatient admission leads to a significantly increased cost for the overall encounter. Future studies should examine interventions that can decrease repeated ED visits and inpatient admission for priapism on a regional and national level.

Disclosure

No
(311) Socioeconomic Risk-Adjustment with Area Deprivation Index (ADI) Predicts Delays to Urethroplasty for Patients with Urethral Stricture Disease
Authors: Watkins E , Koch G , Ayangbesan A , Gambrah H , Bhalla R , Cabo J , Hill S , Johnsen N
Published: May 2023

Introduction

Treatment of urethral stricture disease with multiple repeated endoscopic procedures has been shown to be both ineffective and costly. While a number of patient and provider factors are known to be associated with likelihood of undergoing multiple endoscopic, little is known about non-clinical factors that can impact care.

Objective

As social inequalities such as living in a disadvantaged neighborhood are known to be associated with poorer overall health, worse health outcomes, and decreased quality of care, the aim of this study was to assess whether neighborhood deprivation is associated with delays to definitive care for urethral stricture disease.

Methods

This study identified patients treated by a single surgeon with urethroplasty between 9/4/2019 and 12/29/2021. Patients with a previous history of urethroplasty, under the age of 18, and those with insufficient follow-up data were excluded from the study. Area deprivation index (ADI) is a composite comprised of 17 factors describing income, education, employment and housing quality based on subject 9-digit ZIP code and obtained from the University of Wisconsin School of Medicine and Public Health Neighborhood Atlas. Scores are normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. Patient addresses were geocoded and assigned a national ADI rank based on residential census block group. For the present study, ADI rank was sub-grouped into least disadvantaged (lower 50%) and most disadvantaged (upper 50%). Multivariate logistic regression was performed to assess impact of ADI score on likelihood of receiving multiple endoscopic procedures prior to urethroplasty. Final model was assessed for multicollinearity and goodness of fit via Hosmer-Lemeshow goodness-of-fit test.

Results

104 patients were included in the final analysis. 44% of patients had undergone multiple prior endoscopic procedures. Patients who had undergone ≥2 endoscopic procedures tended to be older, have higher ADI scores, and were more likely to be white. Median time to urethroplasty was significantly higher in those who had undergone multiple prior endoscopic procedures (88 mos vs 12 mos, p<0.001). On multivariate analysis adjusting for age, ADI classification, and insurance status, patients in the more disadvantaged group were significantly more likely to have undergone multiple endoscopic procedures prior to urethroplasty (OR 2.79), as were older patients (OR 1.04).

Conclusions

Neighborhood disadvantage as assessed by the ADI provides an alternative methodology to identify disparities in health services utilization in patients with urethral stricture disease. These findings highlight needs to increase provision of urologic resources and care to disadvantaged communities.

Disclosure

No
(327) The Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT): A Novel Psychometric Tool to Evaluate Premature Ejaculation During Masturbation
Authors: Xi Y , Zhang H , Colonnello E , Limoncin E , Jannini E , Zhang Y
Published: May 2023

Introduction

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include non-vaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus.

Objective

To validate a new tool, the Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse.

Methods

We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated.

Results

The overall Cronbach alpha was 0.884. In our adjusted model, both RMSEA (Root Mean Square Error of Approximation) and SRMR (Standardized Root Mean Square Residual) were lower than 0.08, while Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non-Normed Fit Index (NNFI), and Comparative Fit Index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943±0.015. The results suggest MPEDT points being ≤5 as “normal”, ≥7 as “PE during self-masturbation” and 6 as “suspected PE”, with the sensitivity of 91.9% and specificity of 88.1%.

Conclusions

An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective and reliable diagnostic tool for the evaluation of the existence of PE symptoms.

Disclosure

No
(334) Robotic Transabdominal Vasovasostomy Following Laparoscopic Vasectomy: A Case Series
Authors: Lundy S , Sabanegh E , Kaouk J , Krishnan J , Parekh N
Published: May 2023

Introduction

A small subset of men undergoing laparoscopic hernia repair will request concomitant vasectomy, which is typically performed via resection of a segment of the intra-abdominal vas deferens near the inguinal ring. Some of these men will ultimately desire vasectomy reversal to restore fertility or alleviate post-vasectomy pain syndrome. Traditional scrotal or inguinal microsurgical techniques are clearly not feasible in this situation, and open surgical repair carries significant morbidity. The use of a robotic approach may offer an attractive alternative to improve visualization and facilitate a patent intra-abdominal anastomosis.

Objective

To demonstrate technical feasibility and report institutional outcomes of robotic-assisted laparoscopic transabdominal vasectomy repair

Methods

IRB approval was obtained. A retrospective chart review of our institutional experience with this operation was performed. Preoperative, operative, and postoperative data was collected.

Results

Three cases were identified with a mean patient age of 43 and mean interval of 6 years (range 3-10 years) between vasectomy and reversal attempt. Two men desired restoration of fertility, and one man desired reversal for testicular pain. All patients had previously fathered children, and mean partner age was 30 years. Port placement was similar to standard W-configuration used for robotic prostatectomy. Mean operative time was 319 minutes and estimated blood loss was 27mL. Two men required a modified Prentiss maneuver to re-route the vas deferens to obtain additional length. Indocyanine green was used in one case to confirm vasal perfusion. Bilateral vasovasostomy was completed in all cases with either a modified one-layer anastomosis using 8-0 nylon or a two-layer anastomosis using 10-0 and 9-0 nylon. Both men undergoing fertility restoration had return of sperm in the ejaculate with a mean concentration of 62 million sperm/mL, and the solitary patient with pain had subjective resolution of his pain.

Conclusions

Robotic transabdominal vasectomy reversal is technically challenging but feasible with an experienced team including a robotic surgeon and andrologist. Outcomes appear to be satisfactory. This technique may be considered for men who have undergone abdominal vasectomy and desire restoration of fertility or treatment of post-vasectomy pain syndrome.

Disclosure

No
(338) Factors Associated with Sexual Inactivity in Patients Diagnosed with Benign Prostatic Hyperplasia
Authors: Vasquez A
Published: May 2023

Introduction

Benign prostatic hyperplasia is a common pathology in patients over 40 years of age, with an important role in male sexual health due to its association with sexual dysfunction, with an elevated proportion of patients with sexual inactivity.

Objective

The objective of this study is to evaluate the factors associated with sexual activity in patients over 40 years of age with a diagnosis of benign prostatic hyperplasia

Methods

A retrospective cross-sectional study of 331 patients with a confirmed diagnosis of benign prostatic hyperplasia between January 2021 and November 2021. Both sociodemographic and clinical data were evaluated to associate them to the IIEF questionnaire15

Results

Of the 331 patients diagnosed with BPH, 68.5% had erectile dysfunction: severe ED 119 (36%) moderate ED 14.2%, Mild/moderate ED 10.6% andMild in 7.9%. Of the 226 patients with ED, only 50 patients (22.1%) treated their erectile dysfunction. In addition, 33.2% had low sexual desire and the overall prevalence of sexual inactivity in more than 1 month was 43%. Sexual inactivity was classified: in 1-3 months: 29, 5%, 3-6 months 15.4%, 12% more than 6 months and 42.9% more than 12 months. The independent predictors related variables of sexual inactivity were: age over 60 years (PR 1.5), not having a sexual partner (PR 3.2), IEEF-15 (Erectile dysfunction RP 9.2) dissatisfaction with the partner (PR 4.9), low sexual desire (PR 2.9), and lack of confidence (PR 2.5), Severity of IPSS (RP 1.7) and urethral catheter carrier (RP 2.4)

Conclusions

Sexual inactivity is common in patients diagnosed with BPH and is associated with age and sexual desire. Independently lack of confidence, erectile dysfunction, not having a sexual partner or dissatisfaction with the partner. Of the specific variables related to prostatic hyperplasia, the only ones related were being a carrier of urethral catheter and IPSS severity, the latter associated with decreased sexual frequency and erectile dysfunction. Cardiovascular risk factors had no independent association unlike what was found in other studies.

Disclosure

No
(340) Sexual Dysfunction in Women with Sickle Cell Disease
Authors: Siva C , Ribeiro A P , Contreras J C , Oliveira A C , Andrade T , Nascimento B , Tiraboschi R , Miranda E , Bessa Junior J
Published: May 2023

Introduction

Sickle cell disease (SCD) is a genetic hemoglobinopathy with clinical and epidemiological relevance. Its clinical manifestations directly affect the quality of life of affected individuals. There is a gap in the literature regarding the approach to aspects related to the sexual and reproductive health of people with sickle cell disease, especially in the female population, given that most of the available studies evaluated men. The aim of this study was to assess the sexual health of adult women with SCD.

Objective

The aim of this study was to assess the sexual health of adult women with SCD.

Methods

We prospectively evaluated 29 women with SCD with a median age 34 (26.5 - 40). Nineteen women had HbSS and 10 HbSC hemoglobinopathies. Quantitative data on sociodemographic, biological, and clinical characteristics were collected. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI).

Results

The median age at diagnosis was 9(1-22) years old, the median age at menarche was 14(13-15) years, and the onset of sexual life occurred on average at 19(16-20) years. Sexual activity was reported by 75.8%. Of the sexually active patients, 40.9% had impaired sexual function (the FSFI total score < 26.55). The Median, FSFI score was 23.5 (1-32.5). The median scores of each domain are detailed in fig 1.The most prevalent sexual dysfunction was hypoactive desire, reported by 72.7% of women.

Conclusions

Sexual function is tremendously affected by SCD in most women. They present a significant decrease in overall satisfaction with sexual life and markedly reduced sexual desire and orgasmic function.

Disclosure

No
(344) The Surgical Outcome of Buried Penis Surgery
Authors: Megson M , Ralph D
Published: May 2023

Introduction

Buried penis is a condition where the penis retracts and becomes hidden beneath the skin. It has a significant impact on quality of life of the patient and can present with a variety of symptom including lower urinary tract symptoms and erectile dysfunction. Whilst there are several causes, obesity is the most common in adults.

Objective

The aim of this study is to assess the variety of different operations performed with patient and surgeon satisfaction rates.

Methods

This is a retrospective study on patients with a buried penis operated on between 2010 and 2020. Data retrieved included presenting complaints, previous surgery, co-morbidities, surgical details and patient and surgeon satisfaction rates with cosmesis.

Results

A total of 141 patients were recruited with buried penis (median age 54, range 20-80). The presenting complaints were inability to void standing n = 30, erectile dysfunction n = 18, small penis n = 94. Aetiological factors included diabetes n=47, vascular disease n=62, penile cancer surgery n= 3 and BXO n= 13. The BMI was recorded in 44 patients (range 23-52) with 7 being morbidly obese (BMI >40). 47 patients had only a weight was recoded with a median of 114kg (range 68-169kgs). A total of 96 (68%) patients had had previous surgery prior to referral and in particular circumcision in 49 patients. The operations performed on the 141 patients were circumcision n=40, scrotoplasty n=35, V-Y plasty n=11, skin grafting n=34, suprapubic fat pad excision n=77, abdominoplasty n=25, malleable penile prosthesis n=7, inflatable prostheses n=7 and division of suspensory ligament n=24. The post-operative length of stay was median 3 days (range 0-52 days) but for abdominoplasty and grafting this was a median of 5 days (range 1-52 days). There were 27 complications (19%); infections (n=15), dehiscence (n=5), haematomas (n=2) The mean follow up was 506 days (range 0-4313 days) with a surgical satisfaction rate of 87% and patient satisfaction of 79%. Of note the highest dissatisfaction occurred in patients having circumcision or suprapubic fat pad removal.

Conclusions

Buried penis is a complex condition with patients likely requiring a combination of surgical techniques. Circumcision alone usually does not treat the problem and may make things worse. A prolonged hospital stay with significant wound complications may occur but the majority of patients are happy with the final outcome.

Disclosure

No
(346) Long Term Experience with AMS-700 CXR™ Prosthesis in High-Risk Patients with Corporal Fibrosis
Authors: Cook G , Nealon S , Badkhshan S , Sanders S , Langford B , Vandyke M , Morey A
Published: May 2023

Introduction

Although commonly utilized for high-risk patients with corporal fibrosis, outcome data for narrow inflatable penile prosthesis (IPP) cylinders are relatively sparse.

Objective

The objective of this study is to assess the outcomes of a cohort of patients who underwent IPP placement with the AMS-700 CXR™ (CXR) cylinders at our tertiary referral center.

Methods

We retrospectively reviewed our institutional IPP database for patients who underwent CXR cylinder implantation between 2007 and 2021. Indications, clinical factors, and surgical outcomes were documented for all patients. Kaplan-Meier survival analysis was performed to illustrate implant survival. Patient satisfaction was assessed with a phone survey in which patients provided feedback on penile length, girth, rigidity, and overall satisfaction with the CXR implant.

Results

Among 1149 IPP surgeries reviewed during the study interval, 49 (4%) underwent CXR implantation with a mean (SD) age of 64 years (±11). Indications for CXR implantation included history of infected IPP (30/49, 62%), ischemic priapism 8/49 (16%), and idiopathic fibrosis (11/49, 22%). Postoperative complications occurred in 6/49 (12%) patients including infection 3/49 (6%), cylinder herniation 2/49 (4%), and glans necrosis 1/49 (2%). Discordant intraoperative corporal measurements were common (13/49, 27%), as were discordant rear tip extender lengths (16/49, 33%). The explantation and revision rates were 3/49 (6%) and 4/49 (8%), respectively. Forty percent (19/48) of patients were available for phone survey response (Figure). A total of 47% (9/19) of patients were dissatisfied with their implant, primarily due to perceived loss of penile length (12/19, 63%) and girth (10/19, 53%). Five (5/9, 55%) of these patients had a history of IPP explantation. Fifty-three percent (10/19) of those surveyed are still satisfied with their implant with 58% (11/19) pleased with the rigidity the CXR implant provides.

Conclusions

Narrow based inflatable penile implants have acceptable long-term survival. Cylinder lengths are often discordant in corporal fibrosis patients. Despite use in a high-risk group, patient satisfaction remains acceptable, although many complain of perceived loss of penile length and girth.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.
(349) Risk Factors for Revision of Inflatable Penile Prosthesis among an Ethnically Diverse Urban Population
Authors: Aalami Harandi A , Labagnara K , Zhu M , Salami A , Babar M , Loloi J , Maria P
Published: May 2023

Introduction

Inflatable Penile Prosthesis (IPP) is an increasingly popular surgical treatment for refractory erectile dysfunction. However, there is a feared complication of infection or need for revision surgery. While the risk, treatment, and prevention of infections following IPP placement has been studied, few studies have reported on the risk factors for revision of implant, particularly among a diverse urban population with high rates of comorbid conditions.

Objective

To identify risk factors for revision surgery after primary IPP implantation among an ethnically diverse urban population with high rates of comorbid conditions. Furthermore, to aid informed consent of patients with refractory erectile dysfunction considering IPP surgery.

Methods

This study was a retrospective review of patients receiving IPP implantation surgery at a large urban hospital between January 2015 and December 2021. The primary outcome was revision or removal of IPP due to infection, device malfunction, or other. Patient characteristics, implant characteristics, intraoperative factors, and 30-day outcomes were compared between groups via Chi-squared, student’s t-test, or Mann-Whitney U test. A multivariate cox regression survival analysis was used to identify risk factors for revision surgery. A Kaplan-Meier survival curve was calculated for identified risk factors.

Results

A total of 489 patients received IPP implantation within the study period with 50 (10.2%) requiring revision surgery. Twenty-two (44.0%) patients had removal or revision of IPP due to infection, 19 (38.0%) due to device malfunctions, and 9 (18.0%) due to other reasons. The average time to revision surgery was 8.7 +/− 2.03 months. History of smoking was identified as a risk factor for revision surgery (p<.01), with 23% of active smokers and 13% of former smokers requiring revision surgery. Active smokers had a 3-fold higher risk of requiring revision surgery (OR: 3.23 [0.35-1.32], p<.01). The use of Arista hemostatic agent, as opposed to Surgicel or Evicel, resulted in a more than 50% reduction in the risk of revision surgery (p<.01). However, this finding fell out of our model when adjusted for smoking status (p=.072). Other characteristics such as age, BMI, race, comorbid conditions, length of surgery, implant size, use of surgical drain, and 30-day outcomes were not associated with risk of revision surgery.

Conclusions

There is a mounting body of evidence associating history of smoking with revision surgery and infection following IPP implantation surgery. Patients with active smoking history should be counseled on the up to 3-fold increased risk of requiring revision surgery. Additionally, further studies should assess the use of hemostatic agents such as Arista in reducing risk of revision surgery.

Disclosure

No
(360) Low-Intensity Shockwave Therapy (LiSWT) Appears to Show Improvement in Erectile Function at 1 Month Compared to SHAM in Men with Erectile Dysfunction
Authors: Ballantyne C , Ali M , Ratcliffe S , Mallawaarachchi I , Ostad B , Beano H , Krzastek S , Bryk D , Clements M , Kennady E , Gray M , Rapp D , Ortiz N , Smith R
Published: May 2023

Introduction

Restorative therapies such as Low-intensity Shockwave Lithotripsy (LiSWT) for erectile dysfunction (ED) have generated substantial interest. Despite growing popularity, a paucity of data exists to confirm efficacy in reversing underlying pathophysiologies of ED.

Objective

We evaluated the efficacy of the Storz® Duolith™ to determine whether active versus sham treatment is superior for treatment of ED.

Methods

We performed a two-arm stratified, single-blinded, randomized controlled clinical trial. Inclusion/exclusion criteria are listed in table 1. A total of 31 patients were enrolled, with 15 randomized to the sham group and 16 to the treatment group. Patients underwent LiSWT with the Duolith™ device delivered twice weekly for 3 weeks, comprising 3000 shockwaves at 0.1 mJ/mm2 delivered to the distal penis, base of penis, and crura. Outcomes included absolute change in IIEF/SHIM score and change in EHS score. Changes in SHIM scores were compared between the treatment arms using Student’s t-test, while changes in EHS scores were compared using Wilcoxon rank-sum test.

Results

Demographic and baseline clinical characteristics were similar between arms. At one-month post-treatment, SHIM scores improved by 3.4 points in the LiSWT arm while no improvement was seen in the sham arm (-3.4 vs. 0.7, p=0.014). This corresponded to a 42.1% improvement in the LiSWT arm and a 0.1% decline in the sham arm. No significant differences were observed in EHS change scores between treatment arms. No adverse outcomes were reported.

Conclusions

The present interim analysis shows improvement in SHIM scores in men undergoing LiSWT for ED. Additional recruitment and follow-up is in ongoing to further demonstrate efficacy and sustainability of LiSWT in the treatment of ED.

Disclosure

No
(362) Testosterone Replacement Therapy for Management of Cachexia: A Review of Current Literature
Authors: Hou S , Singh A , Dhindsa S , Hsieh T M , Raheem O A
Published: May 2023

Introduction

Cachexia is a progressively debilitating loss of skeletal muscle often seen in late-stage chronic medical diseases, such as cancer, HIV/AIDS, chronic obstructive pulmonary disease (COPD), and liver cirrhosis. Cachexia contributes to mortality and morbidity with reduced quality-of-life (QoL) and disease treatment options, and can be associated with adult-onset hypogonadism (AOH), which is commonly treated with testosterone replacement therapy (TRT) in men.

Objective

This comprehensive review highlights the current literature on TRT for management of patients with chronic disease-associated cachexia, with an emphasis on clinical outcomes and side effects. Specifically, we identify and highlight relevant primary literature and reviews published since 2000 on TRT for management of patients with cancer, COPD, HIV/AIDS, and liver cirrhosis.

Methods

A comprehensive PubMed literature review was performed to identify articles published between 2000-2021 on TRT and cachexia-related chronic medical diseases (cancer, COPD, HIV/AIDS, and liver cirrhosis) to highlight the use of TRT for management of AOH in male patients with cachexia. The list of studies generated by the initial search was screened to identify eligible studies. Inclusion criteria included primary literature with clinical outcome measures related to changes in lean body mass, muscle mass, body composition, QoL, fatigue scores, and/or exercise scores, in addition to relevant meta-analyses.

Results

12 studies were included in our review out of 653 initial search results (Table 1). In three studies of TRT in cancer patients, there were mixed results on the effects of TRT on QoL assessment. Across three studies of TRT in COPD patients, there was consistent improvement in exercise capacity and disease condition with TRT. Across four studies of TRT in HIV-infected men, TRT resulted in notable improvement in body weight, muscle mass, function, and QoL. Lastly, in two studies of TRT in patients with cirrhosis, testosterone therapy improved muscle strength and body composition across both cohorts.

Conclusions

Based on recent studies, there is robust data for the clinical benefits of TRT for the management of certain subgroups of cachexic patients, specifically those with COPD, HIV, and liver cirrhosis. Because of mixed results in cancer cachexia patients, further investigation of its long-term efficacy is warranted, in addition to hormonal therapy for female cachexic patients.

Disclosure

No
(368) Stuttering Priapism: A Rare Manifestation of Underlying Malignancy
Authors: Lyons C , Crain D
Published: May 2023

Introduction

First described by Peacock in 1938, malignant priapism (MP) is defined as persistent erection in the absence of sexual stimulation or other triggering factors. The proposed mechanism is due to neoplastic invasion of cavernous sinuses and venous system resulting in poor outflow and painful penile engorgement. Though rare, MP due to penile tumors has been described in cases of hematologic malignancies, primary penile neoplasms, local invasion from urologic primary tumors including prostate and bladder cancer, and penile metastasis from other primary sources.

Objective

Here we describe a case of metastatic epithelioid sarcoma that presented with recurrent priapism.

Methods

An otherwise healthy 43 year old male presented with two weeks of intermittent priapism. Initially thought to be traumatic in nature, the patient was managed conservatively with penile irrigation and phenylephrine. Though the patient achieved some improvement in his pain, full detumescence was never achieved. Approximately one month later the patient elected for placement of an inflatable penile prosthesis (IPP) due to persistent incomplete detumescence. At the time of surgery, extensive corporal induration was noted bilaterally. Upon entry into the corpora, copious purulent material was expressed from the tissues and the decision was made to abort the case. Prior to closure, several representative biopsies were collected.

Results

Blood gas performed at initial presentation was consistent with low flow priapism. Doppler studies showed intact arterial blood flow to the penis bilaterally and pelvic MRI was negative for penile injury though asymmetric enhancement of the corpora was noted incidentally. Surgical pathology revealed an unclassified malignancy and increased proliferation concerning for metastasis. A PET scan was performed which was consistent with widely metastatic disease with mets to the liver, lung, bone, muscles, adrenal glands, brain, and penis. Percutaneous biopsy of an abdominal mass confirmed the diagnosis of epithelioid sarcoma. Despite palliative chemotherapy and radiation the patient succumbed to his cancer just two months after diagnosis.

Conclusions

Epithelioid sarcoma is a rare soft tissue neoplasm primarily affecting young adult males and representing less than 1% of soft tissue sarcomas. Even rarer is the incidence of metastatic penile tumors, with fewer than 500 cases reported in the literature since 1850. A literature review by Lin YH et al based on reports from 2006 to 2011 suggested that the true incidence of penile metastasis may be higher given that 12% of penile metastasis may be asymptomatic and discovered only at autopsy. To our knowledge, this is the first case of widely metastatic epithelioid sarcoma presenting with priapism secondary to penile metastasis.

Disclosure

No
(370) The Prevalence and Genotype Distribution of Human Papillomaviruses among Men in Korea
Authors: Ahn S , Moon D , Hwang W , Cho S , Lee H , Park H
Published: May 2023

Introduction

Human papillomavirus (HPV) prevalence and genotype distribution are different between various nations and regions. Additionally, previous studies have mainly focused on HPV infection in women and epidemiological studies of HPV infection in men have been rarely reported. The lack of information on the HPV genotype distribution of men in each individual country or region raises questions about the effectiveness of the current 9-valent vaccination.

Objective

Therefore, we aimed to investigate the HPV infection status in men in Korea to establish vaccine-based HPV prevention strategies.

Methods

Between January 2014 to June 2022, samples of 44,065 men, who were volunteered for testing or recommended to be tested by a clinician, were tested for the HPV detection and genotyping. Samples were collected from the coronal sulcus, glans penis, shaft, and scrotum. HPV detection and typing was conducted using the Anyplex™ II HPV 28 Detection system, which detects 19 high-risk (HR) HPVs and 9 low-risk (LR) HPVs.

Results

Overall HPV prevalence was 59.7%, and overall prevalence of HR and LR HPVs were 30.6% and 50.1%, respectively. The most prevalent genotypes of HR were 16 (5.2%), 53 (4.6%), 51 (4.2%), 52 (3.8%), 58 (3.7%), 39(3.6%) and 66(3.4%). Overall HPV prevalence was not associated with age. However, the prevalence of HR HPVs in teens (34.1%) and 20s (33.8%) were significantly higher than in other age groups. Of the 26,299 men with HR HPV infection, 9259 (35.2%) had a genotype that could not prevented by the 9-valent vaccine.

Conclusions

In this study, men aged under 30 years show high prevalence of HR HPVs. A significant number of infections of genotypes that were not prevented by 9-valent vaccine were observed. Based on this, it is considered necessary to evaluate the usefulness of developing HPV vaccination for men.

Disclosure

No
(371) Testosterone Levels after Lung Transplant: An Analysis of the TriNetX Research Network
Authors: Omil-Lima D , Jaime Abraham Perez J A , Thompson A , Jesse E , Khera M , Chavin K , Thirumavalavan N
Published: May 2023

Introduction

Men with end stage organ dysfunction or failure are more likely to have low testosterone. In the case of men with heart and kidney failure, improvement in testosterone levels are seen after successful transplantation. Limited data exists regarding the natural course of serum testosterone after lung transplant.

Objective

To report incidence of low testosterone in men prior to lung transplant and to determine changes in testosterone levels after transplantation.

Methods

We compiled all clinical data from the TriNetX research network, a globally federated health research network (with waiver from Western IRB) that provides de-identified clinical information from 58 heath care organizations, and over 80 million patients located within the United States. We selected male patients (aged ≥ 18) with a history of lung transplant and testosterone levels recorded before and after transplantation. All men who had a recorded prescription for testosterone therapy were excluded. For all patients, we collected clinical information including demographics, comorbidities, laboratory findings, and medication use. Patients were stratified by testosterone levels and grouped into those who had low serum testosterone versus those with normal levels, with a cut-off point of 300 ng/dL. Patient characteristics were compared using descriptive statistics. Propensity score matching was performed between the two groups to normalize differences in pre-operative characteristics. Mean serum testosterone levels before and after transplantation was compared using a paired T test to determine change in serum testosterone levels after successful transplantation.

Results

A total of 37 men were identified with history of lung transplant, and testosterone levels recorded before and after transplant. Average serum testosterone level in the year prior to lung transplantation was 301.57 +/− 163.25. After transplantation, average serum testosterone was 332.37 +/− 200.92, for a mean difference of 30.80 (p = 0.4815). Prior to transplantation, 24 (65%) men met criteria for low serum testosterone. After transplantation 17 (46%) men demonstrated serum testosterone less than 300 ng/dl. Among men with low serum testosterone, average testosterone levels in the year prior to lung transplantation was 203.29 +/− 66.57, and was 332.37 +/− 200.92 after transplantation (p = 0.0057).

Conclusions

Among men with low serum testosterone receiving lung transplant, transplantation was associated with rescue of low testosterone levels. Further research incorporating a larger cohort is required to determine which patients recover endocrine function after lung transplant and whether etiology of chronic lung disease results in different outcomes after transplantation with regards to serum androgen level and function.

Disclosure

No
(400) Robotic-Assisted Intra-Abdominal Vasovasostomy
Authors: Mikesell C , Lundy S , Krishnan J , Parekh N
Published: May 2023

Introduction

Microscopic-assisted vasovasostomy is a well described procedure used to manage obstructive azoospermia. Intra-abdominal obstructive azoospermia poses a challenge and various techniques have been described, including both open and minimally invasive approaches. The wide-spread adoption of robotics within urology has led to multiple reports of robotic-assisted vasovasostomy, which offers a feasible solution for this challenging problem.

Objective

We describe our technique for robotic-assisted intra-abdominal vasovasostomy in a patient with intra-abdominal obstructive azoospermia.

Methods

A 52 y/o male with past surgical history of right laparoscopic inguinal hernia repair with mesh and concurrent bilateral laparoscopic vasectomy presented to our institution with desire for fertility. He elected to proceed with robotic-assisted intra-abdominal vasovasostomy.

Results

We present and describe our technique for robotic-assisted intra-abdominal vasovasostomy. Post-operative semen analysis confirmed the presence of motile sperm.

Conclusions

We conclude that robotic-assisted intra-abdominal vasovasostomy is a feasible approach to intra-abdominal vasal obstruction. This can be a technically challenging procedure, particularly in the setting of previous laparoscopic inguinal hernia repair with mesh.

Disclosure

No
(402) Analysis of Peyronie’s Disease Injection Techniques
Authors: Masterson T , Lesdesma B , Khodamoradi K , Ziegelmann M
Published: May 2023

Introduction

Collagenase clostridium histolyticum (CCH) is the only food and drug administration (FDA) approved intralesional medication for Peyronies Disease (PD). The manufacture instructions recommend a single injection into the plaque at the point of maximal curvature. However, a 2019 survey of the Sexual Medicine Society of North America (SMSNA) found that physicians were utilizing many different injection techniques. It is unknown if one technique is superior.

Objective

To assess delivery of medication into PD plaques using an invitro model.

Methods

We obtained PD plaques from men undergoing plaque excision and grafting. Plaques were stored at -80C until ready for use in the lab. We injected the plaques with 0.25ml of Eosin Y, 5 wt. 5% solution in water because this solution is visibly red and similar to the density of CCH. We assess how the dye spread through the plaque in four different injection techniques: single injection, single injection with slow pull back, multiple site injection and lateral injection. All injections were video recorded in real time.

Results

Dye was retained inside the plaques will all injection techniques, however in all conditions, a significant amount of dye leaked out of the plaques. Multiple injection technique appeared to have the least about of dye leak out of the plaque.

Conclusions

In all conditions, dye leaked out of the plaques, however the multiple injection technique appears to have deliver the greatest amount

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
(403) Artificial Urinary Sphincter Implantation for Severe Post-Prostatectomy Incontinence in Setting of Salvage Radiotherapy and Prior Inflatable Penile Prosthesis
Authors: Hou S , Cooper C A , Sloan M J , Raheem O A
Published: May 2023

Introduction

Artificial urinary sphincter (AUS) implantation is one of the most common treatment options for individuals with severe stress urinary incontinence (SUI), which is a common complication after radical prostatectomy (RP). The modern AUS consists of a urethral cuff, pump, and reservoir, which serves as a replacement for the native incompetent sphincter. There are various surgical approaches for AUS insertion, including transperineal, transscrotal, and abdominal approaches.

Objective

This video covers the surgical technique for the implantation of an AUS for management of SUI. Notably, this patient underwent RP followed by salvage radiotherapy (XRT) for biochemical recurrence of prostate cancer and had prior inflatable penile prosthesis (IPP) placement.

Methods

A standard step-by-step surgical technique for placement of an AUS through a perineal incision and additional counter incision to allow for high submuscular placement of the pressure-regulating balloon is demonstrated in this unique case of a patient with prior IPP placement and salvage XRT.

Results

We highlight a meticulous dissection around the urethra in a case that had a challenging urethral dissection secondary to prior radiotherapy and a prior IPP in the proximal corpora. The AUS pump was successfully placed in the subdartos pouch of the scrotum on the contralateral side to avoid the patient’s prior IPP pump. At the conclusion, a flexible cystourethroscopy showed adequate AUS cuff coaptation and cycling.

Conclusions

This video covers the step-by-step technique for insertion of an AUS with a transperineal approach in the unique context of a patient with prior IPP placement and XRT. Preoperative counseling, evaluation, and careful intraoperative dissection of key parts of the procedure are critical for successful placement of the AUS, especially in patients who are at high-risk for complications, such as in this case.

Disclosure

No
(406) The “Kiel Knots” Technique for the Treatment of Congenital and Acquired Penile Curvature
Authors: Ragheb A , Osmonov D
Published: May 2023

Introduction

Penile curvature is not only a cosmetic issue, but can also cause severe organic and psychological problems in the affected patients. It can negatively affect the quality of the person’s sexual life or even ruin a relationship. There are many surgical techniques for correction ranging from the least invasive as plication to more invasive as incision or excision and grafting.

Objective

We propose a surgical technique for the correction of both congenital and acquired penile curvatures. Our technique is based on modifying and combining the 16-dot and the Essed-Schroeder plication techniques by burying the knots in shallow troughs of the incised tunica albuginea. We entitle this modification as the “Kiel Knots”. In this video, we demonstrate step-by-step the Kiel Knots technique for the correction of a case of dorsal acquired curvature with good erectile function via the subcoronal approach.

Methods

A circumcising incision is made and the penis is degloved. Buck’s fascia is then incised exposing the tunica albuginea opposite the curvature. Eight dots 5mm apart are marked bilaterally on the tunica albuginea with the point of maximum curvature in the center and a 5 mm superficial incision along the marks is made without cutting into the corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification entails utilizing a separate suture for every two dots with the knot being buried in the shallow trough we created by the scalpel.

Results

Our average operative time is an hour. An average loss of penile length of 0.5-1cm has been reported in 30% of our patients. All our patients preserved their erectile function. 90% of our patients remained without recurrence of curvature after 2 years of surgery. None of our patients reported problems with their suture knots.

Conclusions

The Kiel Knots technique achieves penile straightening with minimal loss of length and no erectile dysfunction. We believe that our technique combines the best of Lue’s 16 dot together with the Essed-Schroeder plication techniques while avoiding the downsides of both approaches.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(407) Buried Penis in Morbidly Obese Patient: Surgical Technique of Fat Pad Excision, Malleable Penile Prosthesis Insertion and Penile Split Skin Graft
Authors: Chiriaco G , Satchi M , Lee W G , Ralph D
Published: May 2023

Introduction

Buried penis has a significant impact on quality of life affecting voiding and sexual function. Central and suprapubic deposition of adipose tissue related to obesity is a common cause.

Objective

This video shows the surgical approach of a complex case of buried penis managed with a suprapubic fat pad excision and simultaneous malleable penile prosthesis insertion.

Methods

We present a case of buried penis in a morbidly obese patient (BMI:43) with a history of two previous gastric bypass surgery and an apronectomy. affecting micturition and sexual function. A skin incision is made with a transverse incision at the level of the anterior superior iliac spine and a curvilinear inferior border. The apex of the inferior border should be approximately 2 finger breadth above the level of the penopubic junction. The incision is extended down to the rectus sheath and the spermatic cords at the lateral boundaries and the penile shaft at the midline are exposed. A malleable implant is inserted using the infrapubic approach and a split skin graft harvested to replace the unhealthy penile shaft skin. The dermis of the skin edges are secured to the rectus sheath with 0/0 vicryl sutures and the wound is closed in layers.

Results

Post-operative recovery was complicated by partial necrosis of the skin graft. At 3 months, the patient was able to stand to void and engage in sexual intercourse at 6 months.

Conclusions

The prevalence of obesity is increasing and in men, the presence of a suprapubic fat bad can result in a buried penis and affect voiding and sexual function. Although weight loss should be advised in the first instance, this may often not be enough. A combination of a suprapubic fat pad excision with malleable penile implantation and spit skin graft is a treatment option that can be considered.

Disclosure

No
(408) THALIA Technique Fixation of the IPP Reservoir
Authors: Wen L , Kemble J , Byrne E , Warner J N , Helo S , Ziegelmann M , Köhler T
Published: May 2023

Introduction

Inflatable penile prosthesis reservoir herniation or migration may occur with space of Retzius or submuscular placement. The dangers of high submuscular placement include bowel or bladder perforation (from blind instrument passage) and or bowel herniation (from unintentional peritoneal placement and stretching of small opening with reservoir filling). Even under direct vision submuscular placement, reservoirs can ultimately reside into the scrotum, retroperitoneum, and lateral abdominal wall. The Tubing, Hitch And Lasso, Intussusception Anchor (THALIA) technique was recently developed to prevent reservoir migration with placement either submuscularly or in the space of Retzius, but video of this technique has not been previously published.

Objective

To visually demonstrate the proper surgical technique of THALIA during IPP reservoir placement.

Methods

An IPP surgical candidate at high risk of complications should reservoir migration occur was identified. Video of THALIA technique performed during IPP surgery was recorded using an in-light overhead camera and a GoPro aseptically positioned on the lead surgeon.

Results

Successful demonstration of THALIA technique during IPP placement.

Conclusions

THALIA technique is a feasible option to aid prevention of penile implant reservoir herniation.

Disclosure

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