bluuebunny/crossref_metadata_2025_split huggingface dataset:
(395) Our Experience with Subcutaneous Injection of Non-Proprietary Testosterone Cypionate as a Novel Approach for Hypogonadism
Authors: Spellman A , Alter K , Levine L 
Published: May 2023

Abstract

Introduction
Subcutaneous injection of testosterone has been investigated as a method of testosterone replacement therapy (TRT) in hypogonadal men. We have been investigating the use of a non-proprietary subcutaneous (SubQ) injection of testosterone cypionate using a ½ inch 27g needle for replacement to treat hypogonadism. This is an update on our work which includes a larger sample size and longer follow up.

Objective
To assess the use of non-proprietary SubQ TRT as treatment in hypogonadal men and its effect on HCT, PSA, and patient satisfaction.

Methods
This study is a retrospective chart review of patients receiving SubQ TRT with a mean follow up length of 9.8 months (range 0-24 months). Patient data was collected prior to initiation of therapy and at subsequent visits. Testosterone, HCT, and PSA were determined through regular blood draws and a patient satisfaction survey was performed over the phone. Univariate analysis and paired t-tests were used to analyze study variables.

Results
41 total patients received SubQ TRT. Mean changes in total testosterone level (increased 281.3 + 81.1, p-value=0.0008), hematocrit (increased 1.5 + 1.0), PSA (increased 0.4 + 0.4), SHIM score (increased 3.8 + 1.4, p-value=0.0088) and AUA symptom score (decreased 0.9 + 1.6) were calculated at the patients’ initial visit and most recent follow up while still on SubQ TRT (Table 1). A total of 30 patients had been on various combinations of TRT before switching to SubQ including IM (13), CC (13) Testopel (8), HCG (2) SubQ (2), T gel (1) and Anastrozole (1). Data on the most frequent TRTs is demonstrated in Table 2. Patient satisfaction surveys were completed by 32 patients (78%), with 26 (81.2%) patients reporting overall satisfaction with SubQ TRT versus 45% (9/20) with past forms of TRT. 93.7% (15/16) reported SubQ TRT was both easier and less painful, and 73.6% (14/19) preferred SubQ injections over their previous form of TRT. Reasons for stopping SubQ TRT included unrelated stroke (1), prostate cancer (1), development of scar tissue (1) or bruising (1), ineffective therapy (1), difficulty drawing up the syringe (1), cost (1), and trouble obtaining medication from the pharmacy (1).

Conclusions
The use of non-proprietary testosterone cypionate SubQ as treatment for hypogonadism results in an elevation in serum total testosterone and improvement on both SHIM and AUA symptom scores at follow up. PSA and HCT rose over the span of treatment, but the rises were not statistically significant, and no patient developed erythrocytosis. Our data demonstrate SubQ TRT is easier and less painful to use and scores higher on overall patient satisfaction compared to other forms of TRT.

Disclosure
No
(404) Early Experience of Penoscrotal Decompression for Refractory Ischemic Priapism and Its Impact on Sexual Function
Authors: Elkholy M , Yafi F , Zahran A , Assem A , Hassan W 
Published: May 2023

Abstract

Introduction
Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours.

Objective
Our objectives are to report our institutional experience using penoscrotal decompression for the surgical treatment of prolonged and refractory ischaemic priapism. The primary end point is to assess priapism resolution in the patients. While the secondary end point is to assess erection recovery in those patients.

Methods
We prospectively evaluated refractory and prolonged ischemic priapism patients treated with proximal decompression from 2020-2022 at Alexandria Main University Hospital. Priapisms were confirmed as ischaemic based on clinical presentations, cavernosal blood gas abnormalities, and doppler ultrasound. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated.

Results
Thirteen patients with priapism who had treated with penoscrotal decompression from 2020 to 2022. Their age was 28-53 years. The duration of ischemic priapism was 48 hours to 10 days. Nine patients had previously undergone shunt surgery. All patients were successfully treated with Penscrotal deecompression without additional intervention and noted immediate relief of pain postoperatively. Of the 10 patients with documented sexual function status at last follow-up, six reported spontaneous erectile function adequate for penetration, while four reported erectile dysfunction.

Conclusions
Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function.

Disclosure
Yes, this is sponsored by industry/sponsor: alexandria main university hospital.

Clarification
Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.
(412) Concurrent Penile Plication and Extratunical Pericardial Grafting for Peyronie's Disease: A Step-by-Step Technique
Authors: Watts H , Casado C , Tanguilig G , Raheem O 
Published: May 2023

Abstract

Introduction
Surgical indications for Peyronie's Disease (PD) may constitute severe penile curvature or deformity including unilateral/bilateral corporal indentation/hinging, hour glassing, and concomitant erectile dysfunction. Penile plication, incision/excision of tunical plaques with grafting techniques are widely used. Recently, extratunical grafting has emerged as newer surgical technique that aims to treat corporal indentation, deformities, or tunical tissue loss in select PD cases.

Objective
In this video, we demonstrated step by step surgical technique for concurrent penile plication and extratunical pericardial grafting via circumcision incision in patient with severe ventral PD.

Methods
Video demonstration was edited using surgical footage with additional explanatory slides and audio.

Results
Video demonstration attached.

Conclusions
This video demonstrates step by step surgical technique for concurrent penile plication and extratunical pericardial grafting that can be used as an adjuvant surgical technique in treating corporal indentation, hinge effect or deformity with or without penile plication.

Disclosure
No
(417) Erectile Function after Treatment for Non-ischemic Priapism
Authors: Gordon P , Ralph D 
Published: May 2023

Abstract

Introduction
Non-ischemic priapism (NIP) is a rare subtype of priapism that typically arises from a straddle injury leading to the formation of an arterial-sinusoidal fistula, which results in partial penile tumescence. NIP can be managed conservatively, with selective arterial embolization, or, rarely, with surgical arterial ligation. These treatments have varying rates of success and post-treatment erectile dysfunction (ED), but there is a paucity of studies that include long-term outcomes. We present long term follow up of 23 three patients in a large centre offering all interventions.

Objective
Follow up 23-patients presenting with non-ischemic priapism, evaluating long term erectile function in both those who did and didn’t require intervention in the form of embolization.

Methods
We conducted a single-centre retrospective cross-sectional study looking at erectile function (EF) in a cohort of 23 patients over a median follow-up of 61 months. Patients’ EF was assessed using the erectile function domain (IIEF-EF) of the British Association of Urological Surgeons (BAUS) International Index of Erectile Function (IIEF) questionnaire, and ED was defined as a score ≤ 25 and/or the use of pharmacological adjuncts to assist EF. This is the largest and longest study in this field of its type.

Results
o Our cohort had a median IIEF-EF score of 28, and 4 patients (17.4%) reported using adjuncts. 21 patients were treated with embolization, and 2 were managed conservatively. o 91.3% required treatment with embolization, 17.4% needed adjunctive agents o 4.3% reported suffering a further episode of priapism (single iatrogenic episode) o 0% ED in conservative management group, 47.6% ED in embolization group.

Conclusions
We had a higher ED rate with embolization compared to the literature (47.6% vs 15-22%). Although no patients treated conservatively had ED at follow-up, there were only 2 patients in this group. Our study’s validity is negatively affected by many factors: its retrospective nature, a small sample size, and confounding from a heterogeneous group of patients. Ultimately, NIP is a rare condition with good treatment outcomes which are constantly improving and evolving.

Disclosure
No
(418) Corpora Cavernosa Reconstruction for Penile Prosthetics Surgery Using a Lightweight Mesh: A Viable Alternative? A Single Center Experience
Authors: Gordon P , Ralph D 
Published: May 2023

Abstract

Introduction
Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ and GORE-TEX™ are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. We present the first experience of using a lightweight mesh for this indication in a single high-volume institution.

Objective
To evaluate long term outcomes of corporal reconstruction using a lightweight mesh measuring where previous options had failed.

Methods
The medical records of all patients undergoing insertion or revision of penile prosthesis between May 2016 and November 2019 were reviewed retrospectively. Patient characteristics, management and outcomes (including patient satisfaction) including any complications were extracted with long term follow up (24-month minimum)

Results
Twenty patients required corpora cavernosa reconstruction during penile prosthesis surgery (median age 56, range 18 to 74 years). Reasons for reconstruction included severe corporal fibrosis due to multiple revisions and deficient tunica (n=7), impending erosion (n=6), congenital corporal agenesis (n=2), aneurysm of cylinder (n=1) ossified Peyronie’s disease plaque excision grafting (n=1) and crossover/perforation (n=3). All but two patients (with corporal agenesis) presented for revision penile prosthesis surgery. Coloplast Titan® OTR inflatable penile prostheses were used in all patients. Two patients (13%) required explant after a mean follow-up period of 7.4 months (+/−2.6 SEM). The first experienced erosion of the prosthesis through the distal corpora 6 months after surgery while the other required explant due to debilitating chronic pain after 3 months. There was no other complication (including infection). All patients (who did not require explantation) were satisfied with their penile prosthesis and are currently sexually active.

Conclusions
Our early results suggest that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction in experienced high-volume hands experienced in revision, reconstruction and salvage procedures. The poliglecaprone-25/polypropylene mesh (ULTRAPRO®, Ethicon LLC, USA) is ideal because it is partially absorbable while providing a strong scaffold, easy to handle and not bulky. Further long-term follow-up is required, and with increasing advances in stem cell tissue engineering perhaps even better graft material choices will be available in the future.

Disclosure
No
(425) Counterincision for High Submuscular Penile Prosthesis Reservoir Placement
Authors: Kavoussi M , Badkhshan S , Nealon S , Langford B , Vandyke M , Sanders S , Morey A 
Published: May 2023

Abstract

Introduction
Inflatable penile prosthesis (IPP) reservoir placement into the high submuscular (HSM) space is safe and well tolerated. Recent studies have proposed that reservoirs placed via an abdominal counterincision (CI) may offer more precise positioning with herniation rates comparable to a transinguinal (TI) approach.

Objective
Our objective was to evaluate the CI-HSM technique with respect to operative time, pain control, and complications.

Methods
We retrospectively reviewed our patient database to identify all men who underwent IPP reservoir placement via the CI-HSM technique. From this database, a similarly sized and matched control group of TI-HSM patients was identified based on concomitant procedures, date of surgery, age, and medical history. Operative time, intraoperative and postoperative complications, morphine milligram equivalents (MME) prescribed, and postoperative patient phone calls were also compared between TI-HSM and CI-HSM patients. Statistical analysis was performed using Student’s T-test and Fisher’s Exact test for continuous and discrete variables, respectively.

Results
Among 580 IPP cases identified, CI-HSM technique was used in 44 (7.6%). Of these, thirty-five (80%) were primary implants, nine (20.4%) were remove/replace revisions, and seven (15.9%) were combined with other ancillary procedures (i.e. artificial urinary sphincter, urethral slings, or penile plications). The TI-HSM technique was used in 536 patients (92.4%); of these, 44 matched controls were identified for comparison to the CI-HSM cohort. Thirty-four (77%) of these patients underwent primary implants while ten (23%) were revision cases. Cases employing the CI-HSM technique had a longer mean operative time (90 minutes) compared to those using the TI-HSM technique (75 minutes) (Table). A similar number of CI-HSM patients (3/44, 6.8%) were treated for infection versus TI-HSM patients (1/44, 2.2%). Reservoir herniation was not observed in the CI-HSM cohort, however one (2.2%) patient in the TI-HSM matched control cohort required revision secondary to herniation. No differences were identified between TI-HSM and CI-HSM patients with regards to outpatient medications, narcotic medication refills, or postoperative phone calls.

Conclusions
IPP reservoir placement via CI-HSM technique is safe and well tolerated. Operative times were similar as compared to reservoirs placed via TI-HSM technique.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(431) Frailty Does Not Predict Postoperative Complications Following Inflatable Penile Prosthesis Surgery
Authors: Johnsen N , Cabo J , Marvi T , Koch G , Gambrah H , Zwaschka T A , Milam D , Kaufman M , Johnsen N 
Published: May 2023

Abstract

Introduction
Frailty, an approximation of a patient’s reserve resulting from age-associated decline across multi-organ systems, has been shown to be an independent predictor of adverse outcomes. Amongst penile prosthesis surgery however, frailty is an underutilized risk factor with conflicting data regarding its impact on surgical outcomes.

Objective
To evaluate the association between the modified Frailty Index (mFI) and adverse outcomes following inflatable penile prosthesis (IPP) surgery.

Methods
A retrospective chart review of men who underwent IPP surgery between 1/1/13 and 7/31/20 at a single-institution was conducted. Patient frailty was defined using the mFI, a previously validated measure, which consists of 11 patient characteristics. Each variable is allotted 1 point with aggregate scores ranging from 0 (no frailty) to 11 (highest degree of frailty). Complications were defined as mechanical failure, erosion, infection, hematoma, intractable pain, or other (ex. herniated reservoir, pump revision). Logistic regression was used to determine the association between mFI and complications after controlling for predetermined covariates.

Results
The final cohort consisted of 337 IPP patients with a median age of 64.6 years (IQR 58.5-68.4) and a median time from surgery to data collection of 66.6 months (IQR 39.0-85.4). The overall complication rate was 9.8% (n=33) with 63.6% of those (n=21) requiring a surgical intervention (ex. explant, remove/replace, revision). The median mFI for patients with a complication was 2 (IQR 1-3) while the median mFI for those without a complication was 1 (IQR 1-2) (Table 1). When adjusting for confounding variables on multivariable analysis, mFI was not associated with either overall (p=0.20) or operative complications (p=0.69) (Table 2).

Conclusions
While specific frailty metrics such as handgrip strength have been shown to be associated with complications following IPP placement, our results suggest that overall mFI was not associated with adverse outcomes following IPP surgery.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(432) Efficacy of Low-Intensity Shockwave Therapy on Hard Flaccid Syndrome: Initial Report of Three Cases
Authors: Hammad M A M , Barham D W , Loeb C , Serefoglu E C , Yafi F A 
Published: May 2023

Abstract

Introduction
Hard flaccid syndrome (HFS) is characterized by chronic pain in the penis and perineum and firmness or rigidity of the penis even while not erect and may have a devastating impact on patient sexual quality of life. Although this syndrome has been discussed in myriad patient forums, there is no established evidence-based definition nor specific standard established treatment modalities in the literature. Current treatment options may include a combination of medical pain management, pelvic floor physical therapy, biofeedback, and stress reduction. In patients with other chronic pain conditions who fail traditional therapies, low-intensity shock wave therapy (LiSWT) has been increasingly utilized as management with positive response. We report a series of three patients with managed with LiSWT.

Objective
To report our initial experience of men with HFS managed with LiSWT.

Methods
Three patients, aged 36, 24, and 20 diagnosed with HFS were treated with LiSWT for a course of six sessions. In each session, LiSWT settings were: energy flux density of 0.13 mJ/mm2 and frequency of 3 Hz. While penis was held in stretched position, 600 shocks were delivered to each of the dorsum, left, ventral, and right aspects of penis along the shaft. The scrotum was then held up, and 600 shocks were delivered to each of the right and left crural areas, adding up to 3600 total number of shocks that were allocated evenly. All patients answered a questionnaire to assess improvement in symptoms after completion of the treatment sessions (Table 1).

Results
All patients reported initially alleviated symptoms after 3 treatment sessions, particularly with respect to penile rigidity in the flaccid state. Patient 1 elected for a combination of LiSWT and tadalafil. 5 months after treatment completion, Patient 1 has had complete resolution of HFS symptoms. Patient 2 had no response with tadalfil alone before he elected for LiSWT only, and patient 3 opted for LiSWT alone. After each LiSWT session, patient 2 reported relieved symptoms for 3-4 days, while patient 3 reported significant improvement lasting for 24 hours. Both patients 2 and 3 reported gradually returning to their pre-treatment baseline in 5 months’ follow-up.

Conclusions
While HFS is becoming increasingly recognized amongst sexual medicine clinicians, there are currently no established efficacious treatment options. LiSWT shows potential as a treatment modality and may have increased efficacy if used in combination with PDE5 inhibitors, as demonstrated in this pilot study. Nevertheless, a larger case series is necessary to establish LiSWT as a standardized treatment option and may require a more comprehensive approach to properly manage this condition.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus.
(445) A Full Bladder Is Not Needed To Grade Male Stress Incontinence For Prosthesis Patient Selection
Authors: Lopategui D , Mallory C , Demus T , Nolte A , Nagoda E , Bui A , Cordon B 
Published: May 2023

Abstract

Introduction
Stress urinary incontinence (SUI) resulting from prostate surgery can have devastating consequences in men’s quality of life. Patient selection is crucial for successful treatment of SUI with urethral sling or artificial urinary sphincter (AUS). The ideal SUI evaluation tool for determining severity and guiding surgical treatment remains unknown. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide a simple, non-invasive assessment of post-prostatectomy SUI severity, and can facilitate procedure selection. However, uncertainty remains as to whether MSIGS underestimates SUI severity if performed with insufficiently full bladder, increasing the risk of treatment failure.

Objective
We present our sling and AUS outcomes using the MSIGS for selection. We assessed bladder fullness with random bladder scans (BS) at the time of evaluation to determine if emptier bladder carries increased risk of failure.

Methods
We conducted a retrospective chart review of male patients undergoing sling and AUS placement. MSIGS and BS were documented at initial evaluation. Additional collected data included age, pads per day (PPD) pre- and post-surgery, post-operative MSIGS, and need for revision or conversion. Success and failure groups were defined as the post-operative use of ≤1 PPD or &gt;1 PPD, respectively. Descriptive and comparative statistics were performed using SAS software.

Results
From April 2017 to September 2021, 40 male patients underwent sling and 43 naïve AUS placement. Average age was 71.9 for slings and 70.3 for AUS. 80/83 had prior prostatic surgery. Average follow up was 12.5 months. 34/40 slings had complete SUI resolution or reduction of pad use to no more than one PPD vs 40/43 of AUS (85 vs 93%, p=0.4). 4 sling patients (10%) had persistence or recurrence of SUI, of whichone patient underwent AUS placement. MSIGS scores were similar between sling success (83% patients grade 0, 3% grade 1, 14% grade 2) and failure groups (67% grade 0, 33% grade 1). 73% of AUS patient mostly had MSIGS scores 3 or 4. BS was available for 35 sling and 25 AUS patients. Average was 18.5cc in the sling failure group (range 17-161) and 38cc in the sling success, (17-161), with 32% of success patients having a BS of 0cc, and 80% of &lt;60cc. Average BS for AUS patients was 45cc (14-224). 10 patients with BS 0 and 7 patients with BS&lt;30cc demonstrated MSIGS 4 on exam.

Conclusions
MSIGS is a non-invasive, reliable test to assess SUI severity. Our preliminary data suggests that a full bladder at time of assessment is not necessary to accurately select patients for male sling vs AUS, with high rate of success and patient satisfaction.

Disclosure
No