bluuebunny/crossref_metadata_2025_split huggingface dataset:
(238) THE USE OF EVARREST(TM) FIBRIN SEALANT PATCH IN PEYRONIE'S GRAFTING
Authors: Dwyer K , Furuyama W , Johnsen N 
Published: December 2024

Abstract

Introduction
Complex and severe Peyronie’s disease often requires operative management with plaque incision/excision and grafting. Grafting materials have varied from autologous saphenous vein grafts to porcine small intestinal submucosa and cadaveric pericardium. Recently, the use of TachoSil collagen fleece has been shown to be successful. In 2012, Evarrest Fibrin Sealant was FDA approved. It has since demonstrated superior hemostatic properties and easier intraoperative use in liver and other solid organ surgeries.

Objective
Herein, we describe our institution’s experience with 20 patients who underwent plaque incision and grafting with Evarrest. We sought to demonstrate the feasibility of its use and describe associated complications.

Methods
This study was conducted via retrospective chart review at a single academic institution. A single surgeon’s case logs between 2020 and 2024 were obtained for all patients with CPT Code 54112, Plaque Incision and Grafting. Of this group, 20 patients were identified who underwent Evarrest grafting. These charts were then reviewed to determine the preoperative characteristics of their disease including curvature severity and direction and postoperative outcomes.

Results
The mean age was 59 ± 9 years (range 44-79) with a mean curvature of 69 degrees. Direction of curvature was most commonly dorsal (n = 14). Nine patients had a concomitant hourglass deformity. Two patients had bothersome plaques without curvature. For most patients, this was their first intervention (n = 15). After incision/excision of the plaque, defect size ranged from 1x3cm at the smallest up to 3.5x8cm at the largest. Two patients underwent simultaneous inflatable penile prosthesis placement. Penile straightening was achieved in 80% of patients, with 3 reporting mild residual curvature and 1 with severe recurrent curvature. Six patients reported numbness or paresthesia, documented at visits between 3-4 months postoperatively. Two patients had wound infections requiring oral antibiotics, and two had hematomas that required drainage.

Conclusions
The use of Evarrest Fibrin Sealant for Peyronie’s plaque incision and grafting procedures is feasible with acceptable post-operative outcomes. As Evarrest is more durable and easier to manipulate than Tachosil, it may serve as an appropriate alternative grafting option.

Disclosure
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(266) UNDIAGNOSED CARDIAC RISK FACTORS ARE HIGHLY PREVALENT IN YOUNG MEN PRESENTING WITH INFERTILITY
Authors: Pereira TA , Siddiq A , Arnold PJ , Rust JO , Bernie HL 
Published: December 2024

Abstract

Introduction
Male Fertility is a marker of overall health. The relationship between cardiovascular risk factors (CVR) and male infertility is an emerging area of interest with prior data showing the incidence of developing cardiac disease over time being greater in men with male factor infertility versus the general population.

Objective
Our study sought to determine the prevalence of CVR factors among young men presenting for infertility evaluation at an Andrology Clinic.

Methods
A retrospective review was conducted on all patients (pts) under the age of 45 years who presented to an infertility clinic between March 2023 and May 2024. Patient demographics, smoking status, comorbidities, Lipid panel ([triglycerides (TG), cholesterol (Chol), low-density lipoproteins (LDL), high-density lipoproteins (HDL)]), Body Mass Index (BMI), blood pressure (BP), and a complete hormone panel were collected. The hormone panel included free testosterone (fT), total testosterone (TT), estradiol (E2), sex hormone binding globulin (SHBG), prolactin (P), follicle-stimulating hormone (FSH), luteinizing hormone (LH), Hemoglobin A1c (HgA1c), and hematocrit (Hct). The hormonal panel was collected before 11 AM using LCMS. Individuals with any missing values were not included in the analyses.

Results
442 men with a mean age of 28.03 years [sd 7.02] were included. The mean BMI was 28.04 kg/m2 [sd 7.02]. In this cohort, only 4.4% of patients had a prior diagnosis of Diabetes Mellitus (DM), 9.4% with Hypertension (HTN), and 5.5% with dyslipidemia (DLP). However, among new pts presenting for infertility evaluation without any known comorbidities 22.0% of pts had elevated HbA1c ≥5.7%, 61.78% had HTN (&gt;120/80 mmHg) on two consecutive reads, 31.5% had elevated TG levels (≥150 mg/dL), 35.0% had low HDL levels (&lt;40 mg/dL), and 38.23% of pts had two or more of these risk factors. 36.6% percent of pts were overweight (BMI ≥25 and &lt; 30 kg/m2), 17.6% were obese (BMI ≥30 and &lt; 35 kg/m2), and 11.2% were morbidly obese (BMI ≥35 kg/m2). 26.0% of pts were smokers, and 21.9% had hypogonadism (TT &lt;300 ng/dL). There was no statistically significant difference in the prevalence of these risk factors among different ethnic groups or ages.

Conclusions
Our study revealed a high prevalence of undiagnosed CVR factors in young men presenting for primary infertility evaluation. Our study underscores urologists' pivotal role in evaluating overall men’s health. Assessing BMI, BP measurements, HgA1c, lipid, and hormone panels in this patient population may be useful parameters to identify young infertile men at risk for cardiac disease and lead to earlier detection of undiagnosed CVR factors and early preventative interventions.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific; Coloplast; BK Ultrasound.
(278) THE USE OF IRRISEPT AT THE TIME OF IMPLANTATION OF INFLATABLE PENILE PROSTHESES REDUCES CULTURE POSITIVITY AT THE TIME OF REMOVAL AND REPLACEMENT SURGERY FOR NON-INFECTED IMPLANTS
Authors: Nosé BD , Grimaud L , Sury K , Foreman JR , Lentz AC 
Published: December 2024

Abstract

Introduction
The inflatable penile prosthesis provides durable management for erectile dysfunction with high rates of patient satisfaction; however, the device is still limited by a mechanical lifespan and the risk of infection. Multiple studies have examined the presence of biofilm at the time of revision surgery with reported rates of positivity being as high as 80%. The advent of antiseptic irrigation, notably Irrisept™ (0.05% chlorhexidine gluconate), has potentially introduced a paradigm shift that may alter the rate of culture positivity during revision surgery.

Objective
To evaluate the antibiogram of organisms isolated during penile prosthesis revision surgery before and after the implementation of Irrisept™ irrigation during the device’s original implantation.

Methods
Data was collected using our institution’s prospectively managed database of penile prosthesis surgery. All 845 penile prosthesis cases from the start of Irrisept use in November 2019 to January 2024 were reviewed. Of the 194 removal and replacement cases for non-infectious indications, operative details from the initial implantation and culture data from the time of revision were available for 72 cases. Of these, 22 had undergone original implantation with use of Irrisept irrigation and 50 were performed without Irrisept use at the time of original implantation.

Results
The patient demographics before and after the use of Irrisept were similar, with average ages being 69 and 65 in the pre and post-Irrisept cohorts, respectively. A higher proportion of patients in the pre-Irrisept cohort did have devices with Inhibizone (54% versus 32%) and increased rates of diabetes (36% versus 32%); however, tobacco use was higher in the post-Irrisept™ population (50% versus 38%). Notably, the percent of cases with positive swab cultures at the time of removal and replacement were 9% in the post-Irrisept group compared to 22% in cases where Irrisept™ was not used.

Conclusions
The use of Irrisept™ antiseptic irrigation at the time of implantation is associated with a decreased rate of culture positivity at the time of removal and replacement for non-infected inflatable penile prostheses.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(280) NO DIFFERENCE IN PENILE PROSTHESIS COMPLICATION RATE BETWEEN ESRD AND RENAL TRANSPLANT RECIPIENTS: A TRINETX COHORT STUDY
Authors: Ward B , Thompson A , Thirumavalavan N 
Published: December 2024

Abstract

Introduction
Erectile dysfunction (ED) is estimated to have 54-66% prevalence among renal transplant recipients. Patients with end-stage renal disease (ESRD) are known to be at significant risk of perioperative complications. However, in men with ESRD, it is unclear whether penile implantation while on dialysis has a benefit over implantation after transplantation. We utilize a large de-identified database to compare complication rates between patients with ESRD and renal transplant recipients.

Objective
To determine whether there is a difference in penile prosthesis complications between patients dependent on dialysis and patients who have received a kidney transplant.

Methods
Using TriNetX Research Network, we identified patients with history of renal transplant, ESRD, or dialysis-dependent status preceding PPP utilizing ICD-10 and CPT codes. Patients were then grouped into a renal transplant or ESRD/dialysis-dependent status cohort. Penile prosthetic-related complications include infection-related, mechanical, thromboembolism, hemorrhage, pain, stenosis, removal without replacement, removal with replacement, and all complications. Kaplan–Meier analysis was performed on the TriNetX platform to compare occurrence of penile prosthesis complications between cohorts and hazard ratios were calculated.

Results
168 and 196 patients were retrieved with median follow up time of 1265 and 1007 days in renal transplant and on dialysis cohorts, respectively. Significant baseline characteristic differences included American Indian/Alaska Native (p = 0.0005) with &lt;6% and 0% in the renal transplant group and dialysis-dependent group respectively and Hypertensive diseases (p = 0.006) with 96% and 89% in the renal transplant group and dialysis-dependent group respectively. No significant differences in post-PPP complications were observed in hazard ratios including all outcomes (HR 1.216, p = 0.154), infection-related (HR 1.068, p = 0.864), mechanical (HR 0.836, p = 0.513), removal without replacement (HR 1.381, p = 0.7385), and removal with replacement (HR 1.269, p = 0.2235). Less than 10 patients in either group were found to have outcomes including thromboembolism, hemorrhage, pain, and stenosis so these outcomes could not be accurately assessed. Less than 10 patients in the dialysis-dependent group were found to have removal without replacement.

Conclusions
The risk of penile prosthesis complications does not appear to differ between men with previous renal transplant compared to men dependent on dialysis.

Disclosure
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(285) DOES A SEPARATE BLOOD SUPPLY TO THE URETHRA DECREASE COMPLICATIONS IN TRANSMASCULINE GENDER AFFIRMATION SURGERY? OUTCOMES OF RADIAL ARTERY URETHROPLASTY IN A LARGE COHORT
Authors: Gobbo A , Li VY , Christopher NA , Ralph D , Lee WG 
Published: December 2024

Abstract

Introduction
Transmasculine gender affirmation surgery (tGAS) is a highly morbid procedure in which the most frequent complications are fistulas and strictures, especially at the phallus level. We hypothesized that the construction of the urethra using the radial artery urethroplasty (RAU) technique, since the urethra is constructed with its own separated blood supply, may lead to an overall lower incidence of complications compared to the integrated phallus urethra construction.

Objective
The purpose of this study is to examine the urethral complication profile after RAU.

Methods
We included patients undergoing tGAS in a three-stage procedure (neophallus-join up-penile prosthesis) between 2014 and 2019 collected from our prospective institutional database. Fistula/stricture occurrence after RAU was recorded and analyzed using the Chi-squared test and univariable logistic regression.

Results
314 individuals with a median follow-up of 4.3y were included. Types of phalloplasty include forearm flap (80.6%), anterolateral thigh flap (7.6%), and abdominal flap with free flap urethroplasty (11.8%). 13% of the patients underwent RAU to construct the urethra or to treat a panurethral stricture following the neophallus construction. 90.2% of the RAU were performed after an abdominal flap. Patients undergoing RAU had a significantly lower number of fistulas/strictures at the phallus level compared to integrated urethras (9.7% vs 39.2%, p = &lt;.001). Logistic regression confirmed RAU as a protective factor (OR = .17, p = .001). A slightly greater number of scrotal or perineal fistulas after the join-up stage were recorded after RAU, however, the finding was not significant (14.6% vs 8.1%, p = .17).

Conclusions
We confirmed the hypothesis that constructing the urethra with a separate vascularization from the phallus assures fewer fistulas/strictures in the phallus, likely because of the better blood supply. We found a non-significant slightly higher incidence of scrotal and perineal fistulas after the join-up stage in individuals who underwent RAU however, larger cohorts are needed to accurately evaluate this aspect.

Disclosure
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(294) A CASE OF METAL RING ENTRAPMENT CAUSING PENOSCROTAL STRANGULATION
Authors: Gillan EC , Alwaal A , Popovic A , Ali D 
Published: December 2024

Abstract

Introduction
Penile “tension rings” have been described as early as the 3rd century in Chinese literature as men were described as wrapping goat eyelids around the base of their penis for increased erection potency. There have been other materials used to prevent blood outflow from the penis during an erection such as rubber bands, plastic bottlenecks, rubber bands, silicone rings, and metal rings. Wearing a penile/penoscrotal constriction device for longer than 30 minutes can lead to serious complications such as tissue edema, ischemia, and eventual necrosis. Thus, if unable to remove a constrictive device, emergent medical intervention is required.

Objective
We report a case of an otherwise healthy 56 year-old male who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours.

Methods
We studied the details of patient presentation, our various treatments attempted, and patient outcome at our institution. We additionally performed a literature review on PubMed (keywords: penile ring entrapment, penile ring strangulation, penile ring treatment) to review other treatment options.

Results
A 56 year-old male with a history of HIV who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours (Fig. 1). Patient was afebrile, hemodynamically stable, and with unremarkable labs. Initial attempts at reducing penoscrotal edema by compression to subsequently slide off the ring using mineral oil were unsuccessful. We then attempted the “string pull” technique by sequentially advancing 0 silk sutures over the ring which was also unsuccessful. We then used an orthopedic bone cutter which was also unsuccessful as the titanium material was too strong. Finally, we resorted to using a Dremel circular rotary saw (which provided to the hospital by the local fire department) to cut the titanium metal ring off in the operating room (Fig. 2). The patient did well post-operatively and passed his trial of void before being discharged on post-operative day one. The patient did not follow up in clinic afterwards.

Conclusions
Penile ring entrapment is a true urologic emergency. Treatment aims to remove the ring while protecting underlying tissue. Treatment is based on case severity and what tools a physician may have at their respective hospital. Noninvasive techniques such as edema compression, lubricant use, and the “string pull” method. When these noninvasive techniques fail, various bone/bolt cutters or saws may be used.

Disclosure
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(303) EJACULATORY DYSFUNCTION ASSESSMENT USING AN EJACULATION SCORE QUESTIONNAIRE IN A SOUTH FLORIDA COHORT
Authors: Cruz J , Farias A , Defauwes N , Prabhakar P , Martinez D , Caso J 
Published: December 2024

Abstract

Introduction
The field of male sexual health has traditionally placed significant emphasis on aspects like erection and orgasm, leaving ejaculation somewhat overlooked. In response, our pilot study introduces the Ejaculation Score, an ongoing evaluation tool specifically designed to assess the ejaculatory process. Ejaculatory dysfunction is a widespread concern among men, yet it has not received adequate attention.

Objective
To evaluate ejaculatory dysfunction, we developed a comprehensive ejaculation score questionnaire to better understand and address these issues effectively.

Methods
The 11-question self-administered ejaculation score was given to patients in an outpatient clinic setting. The questionnaire response was recorded among all patients presenting to the male sexual health practice in South Florida. Based on the overall scoring, the ejaculation score was scored as mild ejaculatory dysfunction (1-10), moderate ejaculatory dysfunction (11-20), and severe ejaculatory dysfunction (21-29).

Results
A total of 221 patients took the self-administered questionnaire. The mean age of the cohort was 53 years (range 24-83). Out of this, 160 patients completed the questions that contributed to the final score. Based on these scores, 93 (58.1%) patients had mild ejaculatory dysfunction, 60 (37.5%) had moderate ejaculatory dysfunction, 6 (3.8%) patients had severe ejaculatory dysfunction, and one patient did not have any dysfunction.

Conclusions
In conclusion, the Ejaculation Score pilot study marks a significant step forward in the field of male sexual health. By shining a spotlight on the ejaculatory process, this evaluation tool addresses a crucial aspect of male sexual function. With ejaculatory dysfunction being a prevalent concern for men, the development of a comprehensive and reliable assessment tool is paramount in understanding and effectively treating these issues.

Disclosure
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(305) MEN WITH PEYRONIE’S DISEASE ARE DIAGNOSED WITH CANCER AT AN EARLIER AGE: GENETICS OR A FOOT IN THE DOOR?
Authors: Kassab J , Oppenheimer A , Huang J , Stocks B , Lipshultz L 
Published: December 2024

Abstract

Introduction
Men with Peyronie’s Disease (PD) are theorized to have an increased cancer risk. PD is characterized by infiltrative growth, proliferation, and decreased apoptosis- pathways shared by malignant neoplastic growth. Thus, one can hypothesize a genetic predisposition toward cancer as heralded by PD pathogenesis.

Objective
To investigate this hypothesis, we identified patients with and without PD over a 28-year period and quantified demographics and cancer incidences.

Methods
We performed a retrospective review of patients cared for by a single urologic provider in Houston, Texas, from 1995 to 2023 and identified those patients with and without PD. These data were sent to the Texas Cancer Registry who identified those patients with a diagnosis of cancer. They returned data including age at diagnosis, cancer anatomic site, and histologic subtype. Data were then studied in detail, and appropriate statistical analyses performed with GraphPad Prism Software.

Results
From 1995-2023 we identified 148 patients with PD and a diagnosis of cancer and 707 patients without PD (controls) and a diagnosis of cancer. Overall, patients with PD were diagnosed at an earlier age across all cancers v. controls (median 59 y v 64 y, p = 0.0008, student’s t-test). The relative frequencies of cancer subtypes were then compared between the PD and control group and log transformed. Overall, we found higher relative frequencies (2-fold difference) of nervous system, ill-defined, intrahepatic bile duct, nasal cavity, oropharynx, and thyroid cancers and lower relative frequencies of kidney, large intestine, and renal pelvis/ureter cancers in the PD group. Regarding histologic subtypes in this cohort, we found higher relative frequencies of bile duct adenocarcinoma, follicular lymphoma, intraductal papillary-mucinous carcinoma, Kaposi sarcoma, and melanoma, and lower relative frequencies of carcinoid, clear cell adenocarcinoma, multiple myeloma, and unspecified neoplasms.

Conclusions
Patients with PD are diagnosed with cancer at an earlier age. Our data aligns with previous work demonstrating higher rates of upper aerodigestive tract and melanoma cancers and lower rates of large intestine and kidney cancers in men with PD. We provide a more detailed and stratified look among histologic cancer subtypes within men with PD. While our data support the genetic similarity hypothesis in which PD and malignant neoplasm share pathologic pathways, it also raises the question of whether PD simply brings patients to the doctor’s office sooner, resulting in increased cancer detection and diagnosis.

Disclosure
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(309) WHAT IS THE RIGHT APPROACH FOR PEYRONIE’S DISEASE SURGERY? COMPARING POSTOPERATIVE WOUND COMPLICATIONS BETWEEN VENTRAL AND SUBCORONAL INCISIONS FOR PATIENTS UNDERGOING PENILE STRAIGHTENING SURGERIES
Authors: Seyer A , Sax-Bolder A , Piraino J , Guillen Lozoya A , Ziegelmann M 
Published: December 2024

Abstract

Introduction
Surgical treatment options for Peyronie’s disease (PD) include penile plication, plaque excision with grafting, and penile prosthesis placement with straightening maneuvers. Choice of surgical incision depends on location and severity of curve, concomitant procedures, and surgeon preference.

Objective
To assess risk of wound complications after PD surgery stratified by ventral versus subcoronal incision type.

Methods
A single surgeon retrospective chart review was conducted for all patients undergoing PD tunica albuginea plication (TA) or plaque excision with grafting (PEG) from Aug 2019 to June 2023. Wound complication was classified as any dehiscence or physical examination finding suspicious for infection within 30d of surgery. A Mann–Whitney U Test was used to compare demographic variables and wound complication rate based on ventral and subcoronal approaches.

Results
Of the 161 patients included, 105 underwent TAP and 56 underwent PEG. All patients who underwent PEG had at least one plication suture performed to correct mild residual curvature after grafting. A ventral midline penile incision was used in 81 patients (50%) and subcoronal in 80 patients (50%). Wound complications within 30d of surgery were found in 10 patients (6%), including 8 (10%) with ventral incisions versus only 2 (3%) subcoronal (OR 4.27; 95% CI 0.87-20.79; p = 0.09). There was no significant difference in wound complications between TAP and PEG cohorts. Wound complications included dehiscence requiring repeat closure (n = 1) and superficial wound infection necessitating antibiotic therapy (n = 9). In a subgroup analysis of patients who underwent TAP only, 8 patients (7.6%) with a ventral approach experienced a 30d wound complication compared with 1 patient (3.4%) with a subcoronal approach.

Conclusions
Penile straightening surgeries are associated with a low rate of significant wound infections. While not statistically significant, a ventral incision may have a slightly higher risk than subcoronal for wound complications within the first 30d of surgery. Both ventral and subcoronal incisions can offer excellent exposure and may be considered for patients requiring plication and/or grafting approaches.

Disclosure
No.