bluuebunny/crossref_metadata_2025 huggingface dataset:
(409) Low Transfascial Fixation of the IPP Reservoir
Authors: Kemble J , Wen L , Byrne E , Khera M , 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 Transfascial Fixation (TFF) 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 TFF during IPP reservoir placement.

Methods

An IPP surgical candidate at high risk of complications should reservoir migration occur was identified. Video of TFF 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 TFF technique during IPP placement.

Conclusions

TFF 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, Boston Scientific, Metuchen Pharmaceuticals, Acerus Pharmaceuticals, Endo Pharmaceuticals, AbbVie Inc.
(410) Multiple Slit Incisions with Tachosil® Grafting for Treatment of Peyronie’s Disease and ED
Authors: Ragheb A , Osmonov D
Published: May 2023

Introduction

Plaque incision or partial excision with collagen fleece grafting and IPP implantation is a well-established treatment for severe penile curvatures associated with ED. Nevertheless, multiple plaque incisions combined with Tachosil® grafting may have added advantages.

Objective

We demonstrate step-by-step the treatment of a case of severe ED with an over 60 degree dorsal curvature mainly on the left side and an hour glass indentation on the right side of the penile shaft. We highlight the advantages of multiple plaque incisions and Tachosil® grafting combined with IPP implantation for these specific cases.

Methods

After IPP implantation via the penoscrotal approach, the neurovascular bundle was mobilized. For the left sided curvature we underwent multiple deep transverse slits starting from and around the point of maximum curvature using a low energy cutting current (20 to 30 Watts). Our transverse incisions were complimented with the modeling technique. For the right sided waist formation we underwent longitudinal slits. The area of incisions was covered by a Tachosil® graft.

Results

The multiple horizontal incisions led to a vertical release thus straightening of the curved penile shaft. Longitudinal slits led to a horizontal release, therefore expanding and obliterating of the waist formation.

Conclusions

The multiple slit technique together with Tachosil® grafting may have added advantages compared to the conventional plaque incision/excision utilizing the same graft. The smaller defects created by the multiple tunical incisions may avoid potential cylinder protrusion, facilitate better sealing of the collagen fleece, lower the incidence of hematoma and/or infections and allow complimentary modeling of the penis. Moreover, complex deformities may also be treated simultaneously with success.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.
(428) Complex Treatment of Venous Leak with Embolisation and Autological Stem Cells Injections
Authors: Knigavko O
Published: May 2023

Introduction

The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low effectiveness. Evermore young patients deny Penile prosthesis implantation for psychological reason.

Objective

We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries (embolization and/or ligation).

Methods

On the basis of Andrology deratment in 2012-2022 we treated 184 patients with VOED. The average patient age is 36.1 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 71 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 106 men. For improving of veno-occlusive mechanism for 78 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results.

Results

The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B (14.3+3.2 and 19.7+3.4). According to Ultrasound and Cavernosography in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B.

Conclusions

Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. This method can be offer as second line therapy of ED for young patients with venous leak.

Disclosure

No
(444) Long-term Outcomes of Inflatable Penile Prosthesis in a VA Practice
Authors: Sax-Bolder A , Van der Voort G , Makedon A , Shahinyan G , Morrison J , Lloyd G
Published: May 2023

Introduction

Inflatable penile prostheses have favorable short-term results for men with refractory erectile dysfunction, but few studies have evaluated the long-term outcomes, including in a VA population.

Objective

This study aims to evaluate the outcomes and satisfaction rates using the novel validated survey, the Satisfaction Survey for Inflatable Penile Implant (SSIPI) of a long-term single-center VA practice.

Methods

Chart reviews were completed as a Quality Improvement project. All patients who underwent a primary inflatable penile prosthesis implantation from 1993-2021 were included. Demographics and data were collected; SSIPI was administered to men who could be reached. Statistical analyses were performed.

Results

114 men were identified, 82 alive and 32 deceased. In the cohort we contacted, mean age at time of surgery was 62.6 years old and mean follow-up 78.2 months (5-234 months). Average SSIPI scores were 64.5/80 (26-80). Smokers were less satisfied with length of penis vs. non-smokers (SSIPI#8 = 2.89 vs 3.93, p=0.032). Men with diabetes were more likely to express regret about undergoing IPP surgery compared to men without (SSIPI#4 = 4.05 vs 4.38, p=0.0029). Men with an ASA score of 2 or less had higher total SSIPI scores compared to ASA score of 3+ (70.36 vs. 61.13, p=0.046).

Conclusions

Long-term satisfaction with IPP in a veteran population appears favorable. However, a significant number of these men still score poorly on SSIPI and/or have complications. The utility of this novel assessment instrument appears excellent. Men with smoking, diabetes, and higher overall comorbidities may find fewer positive results.

Disclosure

No
(450) Max And Average Flow Rate Are Correlated With Severity Of Erectile Dysfunction On Men With Symptomatic Benign Prostatic Hyperplasia
Authors: Habous M , Giona S , Binsaleh S , Almannie R , Ralph D , Bittocchi C
Published: May 2023

Introduction

Numerous cross-sectional epidemiological studies have reported a clear and clinically significant association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging men worldwide.

Objective

We aimed to investigate the severity of ED symptoms with flow rate specifically

Methods

All patients came to our urology clinic, complaining of LUTS for at least 3 months were prospectively included in this study, in one year. Complete medical history including international index of erectile function (IIEF-5) and international prostate symptom score (IPSS) questionnaires, physical examination and comorbidity profile were collected. Patients were stratified according to IIEF-5 score into 4 groups: no or mild ED, mild to moderate ED, moderate ED and sever ED. Standard urofowmetry test was done, and prostate size was calculated through transrectal ultrasound (TRUS). Patients with middle lobe, urethral stricture and previous lower urinary tract surgery were excluded from the study. Database was done with Microsoft Excel and statistical analysis was done by SPSS software.

Results

166 patients had complete data and were included in this analysis. The mean age was 57,and 26% were diabetic. When running Kruskal-Wallis Test it, showed that there is a statistical difference between the groups, the lower is the IIEF score (sever ED), the lower is the max flow rate (P<0.049) and the average flow rate (P<0.025). There was an inverse correlation between max flow rate and Prostate volume, the bigger is the prostate the lower tend to be the max flow rate (p<0.000), and same for average flow rate (P<0.001). There was a slight but significant (P<0.006) increase in severity of ED with the increase in prostate volume. The older were the patients the worse is the ED and the worse the flow rate (p<0.000). The flow rate was neither correlated with dyslipidemia nor with BMI.

Conclusions

Flow rate is correlated with severity of ED symptoms and prostate volume.

Disclosure

No
(452) Glans Necrosis is Not a Risk for Simple Inflatable Penile Prosthesis Insertion Performed via Subcoronal Incision
Authors: Park S H , Wilson S
Published: May 2023

Introduction

Some studies have questioned subcoronal incision via IPP as a risk factor for glans ischemia or necrosis. We analyzed the largest ever reported series of IPP via subcoronal incision.

Objective

To report complications related with subcoronal incision for IPP placement

Methods

We studied 898 men who had subcoronal IPP placement from 5/2015-3/2022 by single surgeon. 817 were first-time patients under local anesthesia, with 81 revisions under spinal anesthesia including 707 circumcised and 181 uncircumcised subjects. Most (76%) uncircumcised men underwent coincident circumcision; the remainder refused. Implants were Coloplast Titan (489) and AMS 700 (329) in 329 (36.6%) diabetics and 38 (4%) Peyronie’s. We report postoperative occurrence of device infections and glans/penile skin problems.

Results

Mean follow up was 47.3 months (3-81 months). Modeling (64%) and corporal relaxing incisions (36%) straightened the Peyronie’s patients. Transient distal penile skin edema which resolved within 2 to 4 months was noted in 673 cases (74.9%). Edema developed in 68.3% previously circumcised patients, 100% of concomitant circumcised patients and 96.2% of patients who had refused circumcision. One previously circumcised patient experienced prolonged edema of 7 months. Five previously circumcised patients (0.5%) developed partial distal penile skin necrosis on the proximal side of the subcoronal incision (Figure-1) with all but one healing without grafting. The other patient sustained necrotic wound dehiscence which led to device infection and removal. There were zero cases of glans ischemia or necrosis. Only 2 patients became infected (0.2%).

Conclusions

Subcoronal incision for simple IPP placement or revision is not an independent risk factor for glans ischemia or necrosis. Most postoperative patients do experience transient distal penile skin edema without glans involvement which heals without sequelae regardless of circumcision status. Very rarely (0.5%) penile skin loss may occur.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, International Medical Devices, Rigicon, Uramix.
(454) Variations in Practice Patterns of Xiaflex Providers Throughout the United States
Authors: Parikh N , Sischka M , Ungerer G , Ziegelmann M
Published: May 2023

Introduction

Intralesional Collagenase Clostridium Histolyticum (CCH; Xiaflex; Endo Pharmaceuticals, Dublin, Ireland) is the only FDA-approved intralesional therapy to treat bothersome penile curvature in men with Peyronie’s Disease (PD). Clinicians who administer CCH must be certified through a risk evaluation and management strategy (REMS) program. However, provider availability is highly dependent on geography and many patients must travel great distances to undergo evaluation and treatment with CCH by an experienced injector.

Objective

The goal of the current study is to describe the landscape of certified CCH injectors with respect to location and clinical background/training.

Methods

Patients are currently able to use an online “locate a specialist” tool through Endo Pharmaceuticals to identify clinicians in their local geographic area who are certified to administer CCH. Using this tool, a list of all providers who offer CCH injections was compiled throughout the continental United States. Pertinent information that was gathered included geographic location, type of provider or level of training [Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Physician Assistant (PA), Nurse Practitioner (NP), and Registered Nurse (RN)], and gender of providers. This information was compared to state population data (United State Census Bureau) to determine per capita coverage.

Results

A total of 1947 Xiaflex providers were identified: 1749 Doctors of Medicine (MD; 90%), 115 Doctor of Osteopathic Medicine (DO; 6%), 60 Physician Assistants (PA; 3%), 21 Nurse Practitioners (NP; 1%), and 1 Registered Nurse (RN; 0.05%). Out of the 1947 providers, only 95 (4.9%) were women. Most women administering Xiaflex were MDs (73%), followed by PAs (12%), NP and DOs (7%), and RN (1%). Xiaflex providers were available in all states except for Hawaii and Alaska. Providers were distributed throughout the United States with the average provider per capita ratio of 230,240. Wyoming, Washington D.C., Rhode Island, and Georgia had the best provider per capita at <10,000 while New Mexico had the worst provider per capita ratio at 2,117,522.

Conclusions

Our results show significant variation in certified CCH injector availability for patients across the United States. < 5% of all certified clinicians are female and 4% were advanced practice providers. Further work is needed to characterize and remedy gender disparities amongst providers, and ensure greater access for patients who desire an FDA-approved non-surgical treatment for their PD-associated curvature.

Disclosure

No
(459) Healthy Effects of Sex
Authors: Dominguez-Bali A , Santana R , Basta J , Belizaire J , Dominguez-Bali C
Published: May 2023

Introduction

Traditionally, sex has been thought of as a function predominantly exercised for reproductive purposes. Likely, religion and culture have both failed to promote a healthy appreciation for the pleasure that sex can provide. Due to the heavy focus on the reproductive utility of sex, society has perpetuated the misconception that increased age reduces libido. As such, the health benefits of sex, particularly in older adults, has been largely ignored as an integral part of preventative medicine. Furthermore, recent studies in the field of neuroendocrinology have demonstrated an increase in the number of receptors for estrogen, progesterone, and testosterone in different tissues of our body, especially in vital organs as brain, heart, bone, and muscle.

Objective

To spread awareness on the importance of maintaining a healthy amount of sexual activity in order to decrease adverse health outcomes.

Methods

In this study, we review the literature extensively and use the sexual histories of patients in our office to assess the beneficial health outcomes.

Results

We present evidence associating increased sexual activity with decreased risk of many disease states. Populations with higher frequency of arousal and orgasms showed reduced rates of breast cancer, prostate cancer, obesity, vaginal atrophy, dyspareunia, dysmenorrhea, dysfunctional uterine bleeding, recurrent urinary tract infections, urinary stress incontinence, fecal incontinence, genitourinary symptoms of menopause, abnormal false pap smears, vulvar, labial, and vaginal obliteration, and cardiovascular disease.

Conclusions

Our findings suggest that increased sexual activity is an important factor for the maintenance of general good health. These findings indicate decline in sexual activity, desire or function, particularly in older patients, as potential risk factors for adverse health outcomes. Promotion of healthy sexual behaviors have been strongly linked to sexual ability at advanced ages, with studies since 1948 showing that over 80% of women with orgasmic dysfunction do not masturbate, while over 80% of women who regularly achieve orgasm do not have trouble masturbating. Sexual literacy and comfort are key factors that may promote healthy sexual activity during adulthood. As such, masturbation should be promoted in adolescent and young adults as part of routine sexual education. Furthermore, standard medical practice should encourage regular sexual activity, with or without a partner.

Disclosure

No
(465) Effect of Anticancer Agents on Erectile Function in Juvenile Rats
Authors: Kataoka T , Hotta Y , Sanagawa A , Hibi Y , Kimura K
Published: May 2023

Introduction

Several cancer chemotherapeutic agents are administered to patients with cancer worldwide. Our previous report on the analysis of the US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database revealed that five anticancer agents (melphalan; L-PAM, methotrexate; MTX, vincristine; VCR, docetaxel; DTX, and doxorubicin; DOX) were proven risk factors for erectile dysfunction (ED). Furthermore, administering these anticancer agents to sexually mature rats reduced their erectile function.

Objective

To investigate the effect of anticancer agents on erectile function in juvenile rats.

Methods

Four-week-old male Wistar ST rats were divided into Control, L-PAM, MTX, VCR, DTX, and DOX treatment groups. L-PAM (3 mg/kg, intravenous, i.v.) and MTX (20 mg/kg, intraperitoneal, i.p.) were injected on day 1. VCR (0.1 mg/kg, i.v.), DTX (5 mg/kg, i.v.), DOX (3 mg/kg, i.v.), and saline (Control, i.v.) were injected on days 1, 8, 15, and 22, respectively. Erectile function was measured following one-, two-, and four-week treatment periods. In the Control, VCR, DTX, and DOX groups, erectile function was also evaluated after four weeks of treatment and a subsequent 4, 8, and 12-week rest period without any treatments. Furthermore, erectile function was evaluated by measuring intracavernous pressure (ICP) and mean arterial pressure (MAP) after electrical stimulation of the cavernous nerve.

Results

After a one-week observation period, the ICP/MAP ratio in the L-PAM group (0.39±0.08) decreased significantly compared to that in the Control group (0.60±0.03) (P<0.01); however, no change was observed in the MTX group (0.59±0.06). The ICP/MAP ratio in the L-PAM group at week 4 (0.66±0.05) increased significantly compared to that at week 1. However, after the four-week observation period, the ICP/MAP ratio in the VCR (0.46±0.04), DTX (0.28±0.01), and DOX (0.38±0.03) groups was significantly decreased compared to that in the Control group (0.66±0.05) (P<0.05). The ICP/MAP ratio in the VCR (0.55±0.05) group after a 12-week rest was decreased compared to that in the Control group (0.68±0.03) (P=0.06). Furthermore, these ratios in the DTX (0.26±0.02) and DOX (0.36±0.02) groups significantly decreased compared to that in the Control group (P<0.01).

Conclusions

In conclusion, ICP measurements revealed that the four anticancer drugs (L-PAM, VCR, DTX, and DOX) significantly reduced erectile function in juvenile rats. Furthermore, in the VCR, DTX, and DOX groups, the erectile function of rats remained compromised 12 weeks post-drug administration. Notably, VCR and DOX are general-purpose anticancer agents for treating leukemia in children, underscoring the requirement for long-term monitoring of the erectile function in cancer survivors. Thus, monitoring the dose and the possibility of recovery after administering anticancer agents is vital, especially considering the risk of developing ED as a side effect.

Disclosure

No
(468) Hypersexuality with SSRI Medication
Authors: Dominguez-Bali A , Harvey A , Farag M , Dominguez-Bali C
Published: May 2023

Introduction

Hyposexuality is a well-defined and prevalent side effect of individuals prescribed SSRI medication. However, hypersexuality has never been found in patients taking SSRI and antitypical antidepressant medications. We present two new case reports to the scanty literature found up to now in this area. This condition needs to be differentiated from the hyperactive arousal disorder already described in the sexological literature. This demands further study. With several documented reports of these side effects, failure to examine and develop therapy options for our patients would be a disservice.

Objective

The objective of this care report is to educate both patients and medical providers of this side effect as well as further investigation to include the pharmacological mechanism involved.

Methods

Two patients presented to the office complaining of hypersexuality. These patients were then followed for four months before completing analysis.

Results

Of the two patients presenting on the drug regimen specified, both experienced hypersexuality.

Conclusions

This case study illustrates that the use of Bupropion and Fluoxetine/Sertraline concomitantly can cause hypersexuality in perimenopausal women. This is an area that needs to be studied more to conclude the mechanism of action.

Disclosure

No
(470) Malleable Penile Implant Rod Diameter Predicts Complications And Patient Satisfaction
Authors: Habous M , Aziz M , Ralph D , Mulhall J
Published: May 2023

Introduction

One of the most common complaints after malleable prosthesis implantation (MPI) is thinning of the penis and decreasing girth. Some surgeons try to insert the largest diameter they can to improve patient satisfaction

Objective

To investigate if malleable rod diameter (MRD) has an impact on outcome and patient satisfaction

Methods

Consecutive malleable prosthesis implanation (MPI) was assessed in a high volume center over one year. The same preoperative, intraoperative, and postoperative protocols were used for all patients and one brand of the malleable device was used only. We recorded MRD and length for all patients. All patients had data on comorbidities including glycated hemoglobin (HbA1c) and clinical Peyronie’s disease (PD). Revision cases and those who lost for follow up were excluded from the study. We also excluded patients operated on by low volume surgeons. All complications, minor (edema, ecchymosis, pain), and major (infection and erosion) were recorded. After 1-year, patients were assessed and given a Likert scale from 1-5 where 1 is dissatisfied and 5 is most satisfied with their MPI. We stratified patients according to MRD into two groups: group A for diameter 9.5 and 11 mm and group B for 13 mm.

Results

183 patients had full data and filled the questionnaire after 1 year follow up. All patients had Coloplast, Genesis penile implants. Major complications rate (infection, erosion, and removal) was significantly higher in group B 11% versus 1.2% in group A (P=0.016). At 4 weeks postoperative visit, 90 % of group A showed no complications versus 60 % only in group B that was statistically significant (p=0.0003). Satisfaction rate was more in patients in group A (88.6%) compared to patients in group B (75.7%)but this did not reach to be statistically significant (P=0.0519). See Table 1.

Conclusions

Larger diameter of malleable penile implants are not always associated with higher patient satisfaction as there are other predictors like postoperative complications and concealement. The best implant size for a certain patient is the best fitting, neither the oversize nor the undersize.

Disclosure

No
(472) The AM-EDITS: A New Tool for Evaluating the Arab Patient and Partner Satisfaction Following Penile Prosthesis Implantation
Authors: Ragheb A , Osmonov D , Abdallah M , Elmarakbi A , Massoud A , Emadeldin M , Abdelbary A
Published: May 2023

Introduction

The Modified Erectile Dysfunction Inventory of Treatment Satisfaction (M-EDITS) is recognized as a useful tool in English language to assess post penile prosthetic implantation (PPI) satisfaction. Nevertheless, a more global questionnaire remains to be introduced for the Arab population, where malleable PPI (MPPI) remains more popular, compared to the inflatable types. Due to the sensitivity of the topic and the conservative nature of the Middle East and North Africa (MENA) region, a scarce body of related research is available.

Objective

Our primary goal was to develop a validated Arabic version of the M-EDITS adapted to the Arabic culture and introduce it as the AM-EDITS. Our secondary goal was to utilize it to investigate the levels of Arab patient and partner satisfaction after MPPI and its sustainability during and after the first 6 months of surgery.

Methods

This was a prospective 6-month follow-up study of 120 patients undergoing MPPI at our unit by a single surgeon. Three telephone encounters were conducted for each couple at 1 month, 3 months, and 6 months postoperative (PO). For our study, we developed a validated Arabic version of the M-EDITS, coined as the AM-EDITS. The first encounter covered general patient perioperative experience, beginning from preoperative counseling till early after surgery. The second and third encounters focused on patient and partner satisfaction regarding implant utilization.

Results

The mean ages for the men and their spouses were 54.7±8.4 and 32.9±4.6 years, respectively. Over 82% of the patients in our study showed a decreased level of anxiety after preoperative counseling. 96% of the patients reported a positive experience regarding their early PO days with above half exceeding their expectations. After 3 months, 82.5% of the men were satisfied, describing their erections to be 80% close to natural. Of the 92.5% satisfied wives at 3 months, 78.5% were highly satisfied. Feeling sexually desirable by their husbands was reported in 93.4%. As opposed to the significant rise in men’s overall satisfaction and AM-EDITS index by 11.6% and 5.2 ± 0.8% (P <0.001), respectively after 6 months PO, partners demonstrated a 12.4% and 5.9 ± 0.8 decline (P <0.001), respectively, compared to the 3 months follow up.

Conclusions

The AM-EDITS may expand the global application of the original M-EDITS. MPPI represents a good quality of life treatment option for middle to low-income countries. Time has a positive effect on the Arab men’s PO satisfaction as opposed to their partners’. These findings should be considered during perioperative counseling of both parties to ensure sustainable satisfaction. Extended studies are necessary to confirm our findings as well as assess long-term PO satisfaction.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
(476) Contemporary Mmanagement of Penile Foreign Body Injections
Authors: Lee W G , Merrett C , Maher E , Ralph D
Published: May 2023

Introduction

Foreign body injections were first used, in the form of mineral oil, in 1899 to augment men post orchidectomy for tuberculous orchitis. In the 1940s and 1950s, documented cases of purposeful penile foreign body injections started to be reported as “penile paraffinomas.” Their surgical correction is challenging due to the risk of skin necrosis and wound breakdown.

Objective

The aim of the study is to present a large case series of 31 penile paraffinomas to examine the management and complication rates in the modern era.

Methods

Retrospective review of penile paraffinomas managed at a single institution over a 15-year period (2006-2021). Patient demographics, surgical management and functional outcomes were extracted from both paper and electronic medical records.

Results

Median age at time of referral was 34 (IQR=10.5). Median age at time of first injection was 30 years (IQR=11.5). The substances injected were silicone (47%), paraffin (25%), mineral oils (22%), and unknown (6%). The most common presenting symptoms was pain (44%) but other reasons included concerns for cosmesis (21%) and penile tightness or phimosis (21%). Only 1 man presented with ulceration and skin necrosis. Most (97%) underwent surgical reconstruction with a median of 2 operations per man (range 1-7) and 66 operations in total. Excision with primary closure was possible in 62% of the operations with circumcision required in 18% (Table 1). Closure was by local tissue flap in 3% but split (5%) or full (5%) thickness skin grafts were sometimes required. Complications occurred in 15% (n=10) with the most common being wound breakdown (n=6) followed by skin necrosis (n=3). There was 1 scrotal haematoma that required surgical drainage (Clavien 3b). Median follow-up after the last operation was 2 months (range 0-19 months) with 70% (n=22) lost to follow-up at some point. Erectile dysfunction and loss of penile sensation were uncommon following surgery (7%, n=2 and 3%, n=1 respectively). Only 7% (n=2) of men expressed dissatisfaction with the overall result of their treatment.

Conclusions

Penile paraffinomas are rare and difficult to treat. Performing repeated staged revision surgery reduces the risk of complications by allowing time for healing between each procedure. Our complication rates are consistent with other contemporary reports. Very few men expressed dissatisfaction with their treatment despite their limited follow-up due to the severity of their presenting problem.

Disclosure

No
(478) Patient and Partner Expectations Before Inflatable Penile Implant Surgery: A Qualitative Analysis
Authors: Vaughan A , Pearlman A , Wentzell E
Published: May 2023

Introduction

Patient and partner expectations before inflatable penile prosthesis (IPP) surgery and satisfaction after IPP have not been well studied.

Objective

The purpose of this study is to qualitatively investigate preoperative expectations of patients and partners.

Methods

Participants included men undergoing IPP surgery for erectile dysfunction (ED) at our institution. We also included interested partners. Information was collected via preoperative telephone interview. Semantic and latent themes were identified using qualitative inductive thematic analysis.

Results

Sixteen patients and 6 partners were interviewed prior to IPP surgery. Patients reported penetrative sex as the preferred form of intercourse (100%), orgasm as the desired endpoint for both participants (86.7%), and diminished self-confidence secondary to erectile dysfunction (66.7%). Partners preferred penetrative sex (60%) and the majority denied orgasm as necessary for their satisfaction (80%). Ideally, patients desired intercourse more than three times per week (87.5%), while partners desired intercourse less than 2 times per week (80%). Most patients reported that their partner was unsatisfied with their sexual activity (93.8%), however patients and partners denied communication with their partner regarding sexual desires or satisfaction (86.7%). All patients (100%) and nearly half of partners (40%) hoped to engage in penetrative sex following IPP placement, while most partners desired restored confidence for the patient following surgery (80%).

Conclusions

Preoperative expectations differ between patients undergoing IPP surgery and their partners. Understanding the impact of these differences on postoperative satisfaction is necessary to identify favorable surgical candidates and provide appropriate preoperative counseling.

Disclosure

No
(485) Utility of Dedicated Andrology Services Among Patients at a Public Tertiary Care Hospital in a Developing Country
Authors: Hegde A , Andankar M , Pathak H
Published: May 2023

Introduction

Patients with andrological problems especially in developing countries do not readily seek treatment with health care professionals. Various barriers to treatment exist including cultural taboos associated with these problems. This has been an unexplored area among Indian patients especially in the public healthcare domain. Public health care set ups in India deal with a huge volume of patients and many set ups do not have dedicated andrology services to handle such patients.

Objective

To evaluate utility and satisfaction with Andrology services among patients at a public tertiary care hospital in a developing country among the out-patient population, an observational questionnaire survey was administered.

Methods

A cross sectional questionnaire survey was conducted on 350 andrology OPD patients over one year. They were given a questionaire that asked basic questions about demographics, sexual habits, education and income level at their initial visit. On follow up, questionnaire recorded the same details along with satisfaction and utility of the andology services to the public at large.

Results

The mean age of the 350 men was 43.4 years; 78% were <50-years-old and 70% had a low income, 60% had low education. 75% patients confessed they were reluctant to seek treatment when they had first symptoms. More than 95% of the respondents were satisfied with the andrology services and hospital environment. All patients felt a confidential environment in a dedicated OPD helped them. The fact that such services were provided at no cost was the most common reason attributed to the high satisfaction rates

Conclusions

Patients frequently consult their peer groups and the internet for information about andrology issues. We believe there should be more awareness about men’s health issues and the options available for treatment. Dedicated andrology services among others, go a long way in bridging the gap. Our study proves that when properly implemented, even in tertiary public hospitals in urban areas, utilization of the service and satisfaction rates remain high.

Disclosure

No
(490) The Ins and Outs of Peyronie’s Disease: An Evaluation of Endoscopic Associations
Authors: Batra N , Reich D , Bird V , Terry R , Yeung L , Campbell K
Published: May 2023

Introduction

Peyronie’s disease (PD) is a fibroproliferative disorder of the tunica albuginea of the penis. Though the etiologies and potential mechanisms for PD remain understudied, known PD risk factors include family history, Dupuytren disease, diabetes mellitus, smoking, hypertension, and penile trauma. Endoscopic procedures have also been reported as a cause of PD. Although often referenced, current literature contains little evidence describing the potential association of endoscopic procedures with the development of PD.

Objective

To evaluate the association of endoscopic procedures and patient demographics in men with the development of Peyronie’s disease

Methods

Institutional review board approval was obtained, and a retrospective review was performed at a tertiary referral center of all patients with history of urologic endoscopy who were subsequently diagnosed with PD from January 2010 to January 2022. Electronic medical records were searched for ICD-9 and ICD-10 codes to identify unique records with a diagnosis of PD. Records were also identified by CPT codes for transurethral and percutaneous urologic endoscopic procedures. Endoscopic procedures were evaluated for the type of instrumentation and divided into 4 broad categories: diagnostic cystoscopy, urethral stricture manipulation, transurethral resection, and endoscopic treatment for urinary lithiasis. Records were evaluated for time to PD diagnosis following their procedure, presence of a post-operative urethral catheter, and demographic data.

Results

A total of 19,383 unique patients with endoscopy procedures and 629 unique patients with PD diagnosis were identified. 121 patients had a diagnosis of PD and history of endoscopy, of whom 50 patients (7.9%) were confirmed to have had endoscopy prior to PD diagnosis. The median age of PD diagnosis was 62. There was no increased association between PD and endoscopy in men with a diagnosis of diabetes (p = 0.5261), hypertension (p = 0.2256), or a history of smoking (p = 0.9398). The majority of PD diagnoses (54%, 27/50) were associated with cystoscopy performed supine (48.1%, p=0.0011), in a clinic (40.7%, p = 0.0001), and with flexible instrumentation (55.6%, p<0.0001). Postoperative urethral catheter use was not associated with PD (p = < 0001. There was no association between the time to presentation of PD and the procedure performed (p=0.73).

Conclusions

Men with a diagnosis of PD and a history of prior urologic endoscopy are more likely to have undergone a simple, flexible cystoscopy in the clinic setting. There does not appear to be an association between the time to presentation of PD and the endoscopic procedure performed.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals
(495) Does Penis Size Matter? Or, Does it Just Matter How it is Measured?
Authors: Wallace C , Snipes M , King S
Published: May 2023

Introduction

There is no popular standardized method for men to measure penis length with countless combinations of measuring implement, side of the penis, degree of penile stretch or erection, and most proximal point. Predictably, methods can yield drastically different results however both physicians and literature rarely elaborate on method of measurement. With how often penis length comes up in discussion in and outside of healthcare, no studies have been performed on the true variety of measurement methods and inappropriate direct comparison of studies with entirely different metrics. Besides quality of their new "erection", penis length is one of the most common concerns of patient's undergoing penile prosthesis surgery for erectile dysfunction.

Objective

To determine the various methods with which a penis can and is measured in order to better manage patients’ expectations after prosthetics surgery.

Methods

Literature review was performed to analyze variation in penile measurement techniques between scientific publications. Tiktok is a popular social media platform where users can create, share, and discover short videos and share comments related to those videos. Several videos on tiktok discussing methods to measure a penis have recently skyrocketed to popularity with as many as 10 to 15 million views and 10-20k comments. Content analysis of users who commented their techniques was performed to inform a short survey posted to tiktok asking users to vote on the most common discrepancies identified in our analysis.

Results

Publications in literature range broadly in method of measuring the penis with the most significant variation due to starting measurement at the pubic bone vs mons pubis. Similarly, early analysis of tiktok comments of the top 5 most viewed videos discussing measuring techniques redemonstrates the same common discrepancies observed in literature review. This study is ongoing but we expect the results of our tiktok survey to prove that there is no common shared method that most tiktok users use to determine penile measurement. While some scientific articles do report more than one measurement of the penis, there is also no research into the accuracy and repeatability of each measurement method to patient’s experience and expectations regarding penis length.

Conclusions

A standardized method for penis measurement will unify the scientific community and patients with concerns relating to penile length whether specific to expectations after prosthesis surgery or otherwise!

Disclosure

No
(497) Is Drug Development for Female Sexual Dysfunction Dead?
Authors: Pyke R
Published: May 2023

Introduction

Various agents have been tested to treat female sexual dysfunction (FSD), particularly Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder, but only two, flibanserin and bremelanotide, have met any regulatory standards (US only), and none is popular with patients or prescribers. Several more agents, e.g., sildenafil, testosterone, alprostadil, buspirone, bupropion and trazodone, have shown early promise but have not been developed further.

Objective

Evaluate whether drug development for FSD at a standstill and identify related factors.

Methods

Selective literature review using the largest, most high-quality surveys available on factors relating to the proportion of women likely to be treated for FSD and of the factors relating to convenience of the posology and the safety of agents for FSD.

Results

Surveys show that about 40% of women have sexual dysfunction, but lack of related distress and complicating factors decrease the proportion of women likely to be treated medically for primary FSD to about 0.1%. Such complicating factors include antidepressant use and chronic medical illness that prevent diagnosing primary FSD, lack of awareness, and prescriber reluctance. The posology of the available agents and their side effects may limit benefits and thus acceptance, also. Fear of regulatory rejection amid shifting standards for evaluation of efficacy and diagnostic criteria is an intangible but likely factor stalling drug development for FSD, too.

Conclusions

Major investment in developing medications for FSD may well have ended. The proportion of women with primary (stand-alone) FSD likely to be treated medically is limited to no more than 0.1% of the population because of low awareness of the diagnosis, lack of willingness to be treated, and lack of prescriber knowledge and willingness to diagnose and prescribe. Benign medications for primary FSD are not available with sufficiently robust efficacy and convenience to break down the barriers of patient and practitioner reluctance toward medical treatment. The lack of marketing success with current agents and the fear of surmounting regulatory hurdles probably have had additional chilling influences on drug development in this field. Developing agents for secondary FSD (FSD comorbid with common chronic medical conditions), e.g., HSDD and/or FSAD in women with the genitourinary syndrome of menopause, diabetes, cancer, depression, and antidepressant users, could help far more women, perhaps 10% of the female population. However, such patients should be expected to be more difficult to treat, might well require multimodal approaches using the biopsychosocial model of FSD. A combination of medication with targeted psychotherapy, couples’ therapy, and/or a mindfulness-based intervention might be necessary.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: S1 Biopharma, Sprout Pharma, Gedeon Richter.
(510) Do Patients with Peyronie’s Disease Perceive Penile Curvature Differently than the General Population?
Authors: Henry A , Lui J , Ziegelmann M , Breyer B , Smith R , Yeaman C , Kern N
Published: May 2023

Introduction

Perception of penile curvature (PC) varies widely, and correction of PC is in the eye of the beholder.

Objective

We sought to investigate if patients with Peyronie’s Disease (PD) had differing opinions on correction of PC compared to general andrology (AD) patients without PD and general urology (URO) patients.

Methods

A cross-sectional survey was administered to adult patients in andrology and general urology clinics at 3 geographically separate institutions. Patients were grouped with having PD vs AD vs URO conditions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction.

Results

Ninety-four PD, 106 AD, and 302 URO patients were recruited. When comparing the 3 groups, besides obvious gender differences with PD patients, PD patients were less in 25-34 age range and more in 55-64 age range (p=0.01 and p=0.007). PD was less represented in Mid-Atlantic (p<0.001). 8% of PD, 12% of AD, and 20% of URO patients chose not to surgically correct any degree of PC (p=0.001). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 52.5° (SD 13) for PD, 37.2° (SD 29.5) for AD, and 51.0° (SD 19.9) for URO patients. When comparing PD patients with AD patients, no difference in the decision to surgically correct was found (p=0.42). This was also found to be the case when comparing PD with URO (p=0.46) and PD+AD patients vs URO (p=0.67). On univariable analysis, among AD patients, those ages 55-64 were more willing to undergo PC correction at lower degrees of PC (p=0.03) but did not hold up on multivariable analysis (p=0.40). No other demographic factors among PD and AD groups were found to have an impact on willingness to undergo PC correction (Table 1).

Conclusions

No significant differences were seen in the decision to surgically correct PC when comparing the perspectives of patients with PD, AD, and URO. Roughly 10% of all of these patients would defer on surgical management of any degree of PC. Despite having PC, no demographic differences were seen among PD patients’ willingness to correct PC.

Disclosure

No