bluuebunny/crossref_metadata_2025_split huggingface dataset:
(185) Trans Obturator Repositioning Sling (TOROS); Novel Proximal Fixation of Penile Prosthesis Cylinder in Neophallus
Authors: Kocjancic E , Pathuri M , Barreto PV , Raheem O 
Published: February 2024

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.