bluuebunny/crossref_metadata_2025_split huggingface dataset:
232 Patient Perception of Penile Size and Device after Penile Implant Revision for Mechanical Failure
Authors: Habashy E , Ziegelmann M , Helo S , Trost L , Kohler T 
Published: April 2022

ABSTRACT

Introduction
IPP revision after implant malfunction yields rare insight into patient preference and perception of penile implant variations in brand and size.

Objective
To assess patients’ perception of their penile implant after IPP revision.

Methods
Retrospective review of all patients undergoing revision surgery for purely mechanical malfunction (fluid leak) at our institution since 2017. Patients with greater than 6 months follow-up after revision were contacted to comment on changes in penile size and device preference. Patients were asked 1. “Did you notice any change in penile length or girth after your last surgery, explain, and 2. “Please describe your preference (if any) of implant and why”. We utilize the Coloplast Titan with “classic” (genesis) pump in most cases, with AMS Cx cylinders being used in cases with attenuated corpora (aneurysm).

Results
21 patients were identified that met criteria with an average age of 70. 15/21 were successfully contacted. 9 Coloplast, 2 Mentor, and 12 AMS devices (Cx =7, LGX =4, Ultrex =1) were revised. Device brand used to replace the broken IPP was n= 19 for Coloplast and n=3 for AMS (Cx =2, Lgx =1). Mean and median time to revision was 9 years overall (2-26) and was similar between Coloplast and AMS. Fluid leak location showed no discernable pattern. Total average implant length increased 2.2 cm from 20.6 cm to 22.8 cm. 8/10 patients were reached that had had both AMS and Coloplast devices (all AMS initially). 12 patients stayed within the manufacturer. Despite change in implanted length, most patients did not discern a definitive change in penile length unless cylinders increased by &gt; 3 cm (perhaps reflecting under-sizing of initial implant). All patients correctly described improvement or no change in penile girth when compared to actual cylinder sizes. Patients preferred Coloplast (6 – girth/erection quality/pump), AMS (1 pump/flaccidity) and undecided (1). Several patients felt consistently cycling the device after revision led to relative length improvement and ease of use.

Conclusions
Our small cohort of IPP revision patients for mechanical failure reveals that revision often requires longer cylinders but this is often imperceptible to the patient. Increased cylinder girth was a key factor in driving device preference.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast
234 Analyzing the Quality of YouTube Videos on Inflatable Penile Prosthesis Surgery
Authors: Paredes-Bhushan V , Patel R , Saunders J , Rezaee M , Gross M 
Published: April 2022

ABSTRACT

Introduction
Video websites, predominantly YouTube.com, offer patients unfiltered and unregulated medical content. Patient commonly use these online medical resources to investigate intimate conditions. It remains unknown whether YouTube videos on penile prosthesis surgery are useful or informative for patients.

Objective
We assessed the quality and reliability of YouTube videos pertaining to penile prosthesis surgery.

Methods
We compiled penile prosthesis videos on YouTube using a combination of multiple pertinent keyword searches. Videos were initially screened by two reviewers. Videos that were irrelevant, not in English, or without audio and also without captioning were excluded. Video demographics and viewership information were collected and categorized by channel type. Videos were then scored by three reviewers. Videos were categorized by themes, which included useful, misleading, or patient views. Reliability was assessed using a modified 5-point DISCERN tool and videos were rated using 5-point Global Quality Scale (GQS). Video comprehensiveness was evaluated using a 5-point content score. Interobserver agreement was assessed using Cohen's kappa score (k) and intraclass correlation coefficient.

Results
Of the 165 videos that initially met inclusion criteria, 23 were hidden or deleted from YouTube at the time of analysis. The remaining 142 videos totaled 1.21 million views, with an average view count of 85,914. Of these, 57 (40.4%) were from universities, professional organizations, non-profits or physicians/physician groups. An additional 56 (39.7%) were medical advertisements from for-profit companies. 20 videos (14.2%) were from individual channels and 13 (9.2%) were stand-alone health information websites. The average reliability score was 3.49 (±1.32), k=0.489. The average GQS was 3.26 (±1.22), k=0.128. The average content score was 1.89 (±1.45), k=0.683. Intraclass correlation coefficient was calculated as for 0.755 for DISCERN and 0.822 for GQS, suggesting strong reliability. 76 videos (53.9%) were identified as self-promotional. 20 videos (14.1%) were identified as patient testimonials. 123 videos (86.6%) were identified as “useful”, 2 videos (1.41%) “misleading” and, 17 videos (12%) as “patient views”.

Conclusions
There is room for improvement in the quality and reliability of YouTube videos pertaining to penile prosthesis surgery. The analyzed YouTube videos also have low content comprehensiveness. Results were consistent across reviewers. Over half of penile prosthesis surgery videos on YouTube are clearly identified as self-promotional by reviewers.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
243 Single Port Robotic-Assisted Removal of an Eroded Inflatable Penile Prosthesis Reservoir and Repair of an Associated Bladder Fistula
Authors: Simon D , Brockman S , Beer A , Tsambarlis P , Chow A 
Published: April 2022

ABSTRACT

Introduction
We present the case of a 73-year-old man who underwent single port robotic removal of a retained Inflatable Penile Prosthesis (IPP) reservoir with intravesical erosion and repair of an associated bladder fistula. The patient had a 3-piece IPP placed in 2014 for erectile dysfunction after radical prostatectomy for prostate cancer. He underwent device explant two years later for infection, at which time the IPP reservoir was “drained and retained”. He developed re-infection one year later and was again taken to the operating room; however, surgery was aborted due to vascular injuries. He presented to us for evaluation of dysuria and gross hematuria six years after initial IPP placement. Work-up with CT imaging and cystoscopy demonstrated intravesical erosion of the retained reservoir.

Objective
We aim to provide a step-by-step video demonstration of our technique for single port robotic-assisted removal of the eroded penile prosthesis reservoir and repair of an associated bladder fistula.

Methods
Procedures were performed using the da Vinci SP single port robotic system. The SP robot port was placed through a 3 cm incision superior to the umbilicus, and an additional 12 mm assistant port was placed in the Right Lower Quadrant (RLQ). The peritoneum was incised anteriorly lateral to the medial umbilical ligament, and the space of Retzius was developed by sharp and blunt dissection through densely adherent tissue planes. The pseudocapsule surrounding the eroded reservoir was incised, and the exposed reservoir was removed. Two fistulous tracts identified between the pseudocapsule and bladder were circumferentially excised, and the resultant bladder wall defect was repaired in a single layer with running 3-0 V-Loc suture. A drain was placed alongside the bladder repair and externalized through the RLQ assistant port.

Results
The patient tolerated these procedures well and without complications. He was admitted for routine postoperative observation overnight after surgery. On postoperative day one, the drain was removed, and the patient was discharged home with the Foley catheter remaining in place. At 2-week follow-up, the patient was recovering well and a cystogram was obtained showing no leaks, and the Foley catheter was removed.

Conclusions
This surgical case report demonstrates the feasibility and safety of performing removal of an eroded IPP reservoir through a minimally invasive approach with the da Vinci SP surgical system. The accompanying video provides a step-by-step demonstration of our technique.

Disclosure
No
244 Penile Entrapment by Metal Ring: A Video Guide to Surgical Removal
Authors: Glaser Z , Selph JP 
Published: April 2022

ABSTRACT

Introduction
Penile rings may be used to enhance sexual function. Prolonged constriction greater than 30 minutes may lead to pain, edema and ultimately ischemic end organ damage. Failure to remove the ring warrants prompt evaluation and can be a surgical emergency.

Objective
The purpose of this video abstract is to review and demonstrate the management strategies to remove a constricting penile ring.

Methods
Conservative interventions which can be attempted at the bedside are reviewed. These include but are not limited to sliding the penile ring off of the penis using available lubrication as well as cutting the rings using pliers or bolt cutters. Interventions performed under general anesthesia include repeated attempts at sliding off or cutting the ring, and when these maneuvers fail, utilization of mechanical drills or saws may be indicated.

Results
The case presented is a 41 year old gentleman who presented with a thick silver metallic ring placed on the base of his penis. The penis had been entrapped for greater than 24 hours. Conservative measures at the bedside were not successful and the ring was ultimately removed in the operating room using a microsurgical saw. The patient experienced a complete cosmetic recovery and did not experience any long-term detriment to his voiding habits.

Conclusions
Prolonged penile entrapment by placement of a constricting ring risks ischemic end organ damage and is a rare surgical emergency. The conservative and more invasive management approaches are demonstrated in this video.

Disclosure
No
101 Penile Prosthesis Utilization After Radical Cystoprostatectomy for Bladder Cancer
Authors: Prunty M , Rhodes S , OBrian D , Jesse E , Callegari M , Arenas-Gallo C , Halpern J , Calaway A , Loeb A , Shoag J , Thirumavalavan N 
Published: April 2022

ABSTRACT

Introduction
Radical cystoprostatectomy for bladder cancer may adversely affects sexual function in up to 80% of men. Penile prosthesis implantation can restore erectile function in these men, but the extent to which penile prosthesis is utilized in this patient population is unknown.

Objective
We aimed to determine the rate of and time to penile prosthesis implantation for men who have previously undergone radical cystectomy for bladder cancer.

Methods
Using the Premier Healthcare Database, we investigated all male patients undergoing radical cystectomy between 2000 and 2020 and identified the subgroup of patients undergoing penile prosthesis implantation. We compared sociodemographic characteristics in men who did and did not undergo implantation. Categorical variables were analyzed with Chi-squared tests and continuous variables were analyzed with Kolmogorov-Smirnov tests.

Results
We identified 142 men who underwent cystoprostatectomy and subsequently underwent penile prosthesis implantation. Among these 142 patients, 16 (11.27%) had a penile prosthesis placed on the day of cystectomy and 106 (74.65%) had a subsequent penile prosthesis placed at a median of 503.5 days (IQR 214-821 days) following cystectomy. Patients who underwent penile implant were statistically younger (64 years vs 68 years, p&lt;0.001) and more likely to have private insurance (39% vs 25%, p&lt;0.001), as compared to patients who did not have a follow up for penile prosthesis.

Conclusions
Sexual function is an important aspect of cancer survivorship and treatment of post-cystectomy erectile dysfunction should be considered a critical component of care. When penile prosthetics were utilized, this occurred with significant delay (median 503.5 days). Efforts to increase education about available treatment options, inclusion of sexual medicine urologists in post-cystectomy care pathways, and decreasing time to penile implantation may all improve quality of life for bladder cancer survivors.

Disclosure
No
118 Does Irrisept Dipping/Irrigation Adversely Affect the Hydrophilic Coating of Titan Implants?
Authors: Karpman E , Klous D , Zhang W , Taylor J , Henry G 
Published: April 2022

ABSTRACT

Introduction
Prosthetic infections occur in 1-3% of virgin implants. Titan penile prostheses (PP) have a hydrophilic coating that can absorb any antibiotic/antifungal solution for infection prevention. The ideal solution for dipping non-coated implants is yet to be described, however, reports of various solutions exist. Chlorhexidine gluconate is a very broad spectrum antibacterial, antifungal and antiviral solution that has been used for skin preparation for surgery because of its excellent profile for known pathogens. Irrisept is the first and only chlorhexidine 0.05% solution that has been FDA cleared for intra-corporal wound lavage in humans. When considering a new dipping solution, we must always weigh the effectiveness of any dipping solution with the caustic properties of the solution on the device and tissue.

Objective
The purpose of this experiment is to determine the effects of Irrisept solution on Coloplast's hydrophilic coating incorporated on the Titan penile prosthesis (PP).

Methods
Pre-connected Titan PP product including both pumps and cylinders were tested. The Titan PP was soaked in Irrisept solution and normal saline for 1, 15, 30 and 60 minutes. After soaking, all parts were dried for 15 minutes in a 35°C oven, and then went through the Congo Red Dye Test. Congo Red dye testing was performed per the approved FDA test method for ensuring product reliability. (Coloplast’ internal Test Method.)

Results
All the PPs tested achieved satisfactory coating results. There was no noticeable effect or difference of coating adherence between the saline soaked control and Irrisept soaked devices. And there was no noticeable effect or difference of coating adherence between different soaking time. (Figure 1 Congo Red stain)

Conclusions
Soaking the Titan PP in Irrisept solution does not effect the hydrophilic coating of the implant when compared to saline. There was also no difference in hydrophilic coating compared to saline controls at various times of dipping (1, 15, 30 and 60 min).

Disclosure
Yes, this is sponsored by industry/sponsor: Coloplast
Clarification: Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
120 Does Partner Involvement Reduce Unanticipated Postop Visits Following Penile Prosthesis?
Authors: Swanton A , Munarriz R , Gross M 
Published: April 2022

ABSTRACT

Introduction
The spouses and partners of patients undergoing implantation of an inflatable penile prosthesis (IPP) are often active participants in the perioperative process. Many urologists encourage partner involvement for penile implant patients, but there is little information on whether this influences their post-operative course.

Objective
This study seeks to determine whether preoperative partner attendance at clinic appointments is associated with deviation from a standard postoperative care pathway for patients undergoing primary IPP placement.

Methods
This is a retrospective study conducted using data obtained from primary IPPs performed by a single surgeon between October 2016 and January 2021. A standardized postoperative course was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine the influence of partner involvement on planned postoperative scheduled visits.

Results
During the study period, n = 170 primary IPP patients were identified and 147 (67%) of these patients had partners. Partners were involved in all perioperative visits for 92 patients (54%). Unplanned follow up visits were seen for 58 patients (34%) between 0-6 weeks and for 28 patients (17%) after 6 weeks postoperatively. Partner involvement was associated with a reduced odds of additional follow up visits, both at 0-6 weeks (unadj: OR 0.43, 95% CI 0.23-0.83; adj: OR 0.40, 95% CI 0.20-0.79) and after 6 weeks (unadj: OR 0.32, 95% CI 0.13-0.76; adj: OR 0.33, 95% CI 0.13-0.81), both in unadjusted analysis and when adjusted for obesity and presence of complications. Clavien-Dindo complications were identified in 29 patients (17%) intraoperatively or postoperatively. Mean surgical time was 69 minutes (SD = 19). Mean patient age was 62 years (SD = 9). Comorbidities included obesity (52%), diabetes (37%), hyperlipidemia (72%), and hypertension (84%).

Conclusions
Partner involvement equated to a 2.5 fold decrease in the odds of unplanned postoperative visits among primary IPP patients. Though the mechanism of this reduction is unclear, having partners attend perioperative visits is easily implemented, low cost, and minimal risk. We would recommend that urologists routinely encourage patients considering insertion of a penile prosthesis involve their partners in perioperative visits.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
127 Penile Prosthesis Now An In office Procedure: A Single Center Experience In The US
Authors: Hakky T , Alexander-Rodriguez A 
Published: April 2022

ABSTRACT

Introduction
Inflatable penile prosthesis (IPP), an implantable device for treatment of ED, historically have always been done in a hospital setting or outpatient setting. These surgeries are now done more frequently around the world as an in-office procedures. With the increase risk of COVID infections and the improvement of IPP technique we began performing this procedure in the office under local and total intravenous anesthesia.

Objective
To present the nuances of office based 3 piece penile prosthesis and the outcome data for the feasibility of in-office implants while minimizing complications.

Methods
A retrospective chart review was performed on the 10 IPP patients who had surgery in the office based setting in our clinic. The age ranges varied from 34-58 years of age. All pateints who opted for IPP in the office were screened for any and history of pelvic surgery, renal failure, cardiac stents or heart failure. Preoperatively, Antibiotics used were Vancomycin, Amikacin and oral Fluconazole and oral Neurontin for analgesia. All patients had a preoperative COVID nasal swab or had the vaccine prior to surgery. Intraoperatively Vancomycin, Amikacin and Fluconazole were used for irrigation and implant prep. Smaller table sets with stacking sterile field was used with headlights and loupes. IV sedation was used with the assistance of an anesthesiologist who used Propofol for sedation. A propofol bolus was given prior to entering the space of retzius. The patients also received a penile and pudendal block with a mixture of 1% Lidocaine, 0.5% Marcaine and 1mg Solumedrol for post-op pain management. Postoperatively, Neurontin and Tylenol were given PO and Toradol was given IV.

Results
Of the 10 patients selected, 0 patients had infections we had even with a drain being in place 2 patients suffered a hematoma. 1 patient suffered urinary retention, resolving after 24 hours. Patients were cleared for device use between 5 to 8 weeks. 1 patient's implant was recalled; however, the patient did not have a desire for re-operation and has the device and works around the valve. The average procedure time was 53.5 minutes. Incision size range was 1.7 cm to 2.5 cm in length.Drains were placed in all patients for 24 to 48 hours with out puts of 90-160cc. Patients were discharged after 90 minutes in recovery phase.

Conclusions
Office based penile prosthesis is safe and feasible in the post COVID world. Nuances such was headlights, loupes and adequate block-aid and sterile field efficiency with preloading and stacking are a necessity. With careful patient selection, in-office implantable penile prosthesis implant can be a safe feasible alternative for patients that have severe ED, have gone through alternative therapies, but either cannot afford and or insurance does not cover this procedure.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
129 Anal Sex and Sexual Function Satisfaction: A Comprehensive (and Critical) Review of Current Medical Literature
Authors: Walton A , Garcia M 
Published: April 2022

ABSTRACT

Introduction
Anal sex is practiced by people of all sexualities, genders and bodies. Despite common practice, there is relatively little in the clinical literature about anal sex from a more sex-positive “sexual health” perspective.

Objective
To review the medical literature related to anal intercourse, with attention to the fraction that focuses on the sex positive aspects of anal sex to address and support the sex-based questions and concerns of adults who practice it.

Methods
A comprehensive literature review was conducted in accordance with PRISMA guidelines, using PubMed. For our search, we generated a comprehensive list of synonyms for anal intercourse and combined them with synonyms for sex positivity (sexual satisfaction, erogenous, pleasure, and orgasm).

Results
We identified a total of 149 articles from the search terms. Of these articles, 59 abstracts were relevant to include and were reviewed. Among these abstracts, 23 manuscripts were reviewed in full and only 20 of these were acceptable for inclusion in this review. Twelve of the twenty papers included in our review were primarily sexual health focused, while the other eight primarily pathology focused. Men who have sex with men (MSM) is the population most considered within the discussion of anal sex. There was a trend towards identifying the influence of external factors on the sexual outcomes of anal sex in MSM, such as condom use, lubricant use, prostate cancer, and drug use. Among women who have sex with men (WSM), 28.4% described the first experience as pleasant and 62.3% continued to practice anal sex. However, almost half of WSM found their first experience to be too painful to continue. Women who have sex with women (WSW) were missing from the discussion of anal sex and sexual health.

Conclusions
Though the medical literature contains an abundance of studies of “sexual pleasure” and “sexual function” these are commonly hetero-normative and focus on penile-vaginal intercourse, and very rarely include anal stimulation/sex. Given that anal sex is widely practiced, the dearth of sex-positive literature focused on anal sex suggests both that patient's practices of anal sex is less commonly queried by providers, and, that there is a need for medical literature to help inform providers and patients about how to make anal sex safer and more satisfactory. Second to the general U.S. population, other small but important subgroups for whom this is relevant include cancer survivors working to recover their sexual health, and transgender women awaiting gender affirming genital surgery. There is a need for more investigation into the sex positive nature of anal sex.

Disclosure
No