bluuebunny/crossref_metadata_2025_split huggingface dataset:
182 Real World Experience with ProACT for Post-prostatectomy Incontinence: First 14 Cases
Authors: Fish P. , Bowen A. , Colvert J. 
Published: April 2022

ABSTRACT

Introduction
While there are several treatment options available for post-prostatectomy incontinence (PPI), the goal of this study is to describe the first United States (US) post-market, real world experience with adjustable balloon devices (ProACT) for PPI.

Objective
Demonstrate real-world learning curve and efficacy of a novel device for male post-prostatectomy incontinence.

Methods
After institutional IRB approval, a retrospective review of prospectively collected data was performed on men treated with percutaneous ProACT implantation from December of 2019 to October of 2020. Data collected on 14 men from an academic practice and a private practice . Data were analyzed using the paired students t-test to determine statistical significance.

Results
The mean patient age was 75.2 years, and the average time from prostatectomy was 7.4 years. A total of 35.7% of patients had mild PPI (0-2 pads per day (ppd)), and 57.1% had moderate PPI (2-5 ppd), and 7.1% had severe PPI (&gt; 5 ppd). Other relevant demographic information includes 7.1% of the study population had previous radiation, and 42.9% of the patients had failed prior surgical treatments (some multiple) for PPI including 2 bulking injections, 3 slings, 1 TUIBNC, an indwelling AUS, and an eroded AUS. At follow up, patients saw a dramatic improvement in continence from 3.2 ppd at baseline to 1.9 ppd at 1 month follow up (p &lt; 0.05), 1.3 ppd at 2 months (p &lt; 0.01), 2.3 ppd at 3 months, 1.4 ppd at 4-6 months (p &lt; 0.01), and 1.3 ppd at 7-9 months (p &lt; 0.01), 0.67 ppd at 10-12 months (p &lt; 0.05), and 0.8 ppd at 13-15 months (p &lt; 0.001). Average length of follow-up data was available for 12.4 months for this cohort. At the most recent clinic visit for each patient 79.6% were dry using ≤ 1 ppd. There was a 28.6% rate of complication, one involving local wound infection cleared by antibiotics and 3 erosions of the device requiring revision. Two of the three revision patients ultimately attained improved continence levels (1.5 ppd and 0 ppd) and one erosion is still pending revision at this time.

Conclusions
Initial real-world experience in the US demonstrates that ProACT adjustable balloons for PPI is safe and efficacious. Longer follow up needed but short-term results are encouraging and statistically significant.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Uromedica
184 Does Medicaid Cover Artificial Urinary Sphincter Surgeries? A State-by-State Analysis
Authors: Loeb C. , Barnard J. , Yafi F. , Schneider D. 
Published: April 2022

ABSTRACT

Introduction
Artificial urinary sphincter (AUS) placement is the most effective long-term treatment for men with severe stress urinary incontinence (SUI), typically due to post-prostatectomy intrinsic sphincter deficiency. Published success rates range from 59 to 90 percent and the procedure is associated with very high patient satisfaction. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population, which may contribute to inequitable utilization of this treatment modality for SUI.

Objective
To quantify Medicaid coverage for AUS placement and revision for male SUI by state.

Methods
State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53444, 53445, 53446, and 53447, which represent insertion of tandem cuff, insertion of inflatable urethral/bladder neck sphincter, removal of inflatable urethral/bladder neck sphincter, and removal and replacement inflatable urethral/bladder neck sphincter. Data were recorded for each device, including the coverage status and physician fees.

Results
Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for removal with and without revision of the AUS, 48 states reported coverage for insertion of an AUS, and 48 states reported coverage for insertion of a tandem cuff. Means and range of physician reimbursement for each AUS related procedure were $1,007.59 ($181.84-$10,960.90) for insertion of tandem cuff (53444), $1,087.40 ($199.89-$11,949.86) for insertion of AUS (53445), $596.93 ($146.90-$1893.12) for removal of AUS (53446), and $1020.14 ($208.55-$11,586.74) for removal and replacement of AUS (53447).

Conclusions
AUS related surgeries in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Interestingly, removal with and without replacement of AUS was covered by all 49 states with publicly reported data. Knowledge of Medicaid coverage for AUS related surgery may result in improvement in the utilization of this treatment for male SUI and may improve access to care in the Medicaid population.

Disclosure
No
214 Reconstruction of AUS Cuff Erosion: Defect Size Predicts Prognosis
Authors: Chertack N , Nealon S , Joice G , Caldwell K , Kavoussi M , Dropkin B , Ortiz N , Baumgarten A , Shakir N , Sanders S , Hudak S , Morey A 
Published: April 2022

ABSTRACT

Introduction
In-situ urethroplasty (ISU) has been proposed in conjunction with device explant as an acute management strategy after artificial urinary sphincter (AUS) cuff erosion. Previous studies have not shown a clear relationship between extent of erosion and long-term prognosis.

Objective
We hypothesize that more extensive erosions are associated with higher rates of lower urinary tract complications (LUTC) and increased need for urinary diversion (UD).

Methods
We performed a retrospective study of patients who underwent ISU for AUS cuff erosion from June 2007 to December 2020 with a minimum of 90-day follow up. Patients were stratified into two groups based on the degree of urethral erosion determined endoscopically at the time of device explant - mild erosions (&lt;33% circumferential defect) and major erosions (&gt; 33%). Outcomes included LUTC, AUS reimplantation, and UD. LUTC was defined as urethral strictures, diverticulum, fistulas, and erosions of a secondary AUS. UD was defined as suprapubic tube placement with or without urethral ligation or ileal conduit creation. Kaplan-Meier curves were created to compare outcomes between groups.

Results
A total of 40 patients underwent ISU for urethral cuff erosion and met the follow-up criteria. Median patient age was 76 years old with median erosion defect size of 46% (IQR: 20-50%); 15 men (37.5%) had mild erosions and 25 (62.5%) had major erosions. The overall LUTC rate was 53.5% with significantly fewer complications noted with mild erosions (28.6% vs 65.4%, p = 0.002) (Figure 1). Ultimately, 35.0% of patients required permanent UD with decreased rates in the case of mild erosions (13.3% vs 48.0%, p = 0.04) (Figure 2). On Kaplan-Meier analysis, mild erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation.

Conclusions
Prognosis after AUS cuff erosion is associated with size of the urethral defect. Patients with extensive cuff erosion are at high risk for LUTCs and permanent UD.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
220 Time to presentation of Peyronie's Disease in the era of injections and information
Authors: Ly L , Morales-Lopez R , Metro M 
Published: April 2022

ABSTRACT

Introduction
Characterized by acquired fibrosis of the tunica albuginea, Peyronie's disease (PD) can cause penile curvature, pain, and plaque, as well as erectile dysfunction and difficulty with penetration. Using online surveys in 2007-2008, Dibenedetti et al found that the prevalence of PD in adult men in the US was 0.5% based on PD diagnosis; 0.8% based on PD diagnosis or treatment of PD; and 13.1% based on diagnosis, treatment, or any symptom of PD. They found that 68% of patients saw a doctor when they first noticed symptoms, at a mean time to see a doctor of 16.8 (SD = 5.5) months. The other third, or 32%, of patients who sought treatment later in the disease course, had a mean time of 46.2 (SD = 8.4) months. Only 5% of patients presented with current pain, thus in the active phase.

Objective
Our study investigated how patient presentation for PD changed after two sentinel events: 1) the FDA approval of intralesional injections of collagenase clostridium histolyticum (CCH) in 2013, and 2) the national publicity surge for PD in 2016-2017. We then aimed to compare this data to a prior study by Dibenedetti et al conducted for patients in 2007-2008.

Methods
Our retrospective, single institution study was conducted as a chart review of patients presenting from 2014 to 2020 with penile curvature, pain, or plaque. Descriptive statistics were used to compile data at the time of initial evaluation by the reconstructive urologist, including patient demographics, pre-treatment assessments, and time to evaluation.

Results
Our study included 152 adult men, and mean age was 57.9 years old (SD = 8.1) (Table 1). Initial symptoms included penile curvature (87%), pain (30%), and plaque (8%). 38% of patients were in the active phase of PD at time of evaluation. The mean time from onset of symptoms to evaluation by the specialized urologist was 27.5 months (SD = 53.2, range 1 to 360 months) (Figure 1). For the 2/3 of patients, or 68%, who had the shortest time to evaluation, the mean duration of PD symptoms prior to evaluation by a specialized urologist was 10.0 months (SD = 4.6) (Figure 2). For the 1/3 of patients, or 32%, who had the longest time to evaluation, the mean duration of PD symptoms prior to evaluation was 69.7 months (SD = 80.6).

Conclusions
Over the years, the majority of PD patients are presenting sooner in their PD course. The outlier patients, or those who have suffered from PD for a relatively long time, are also presenting for evaluation and treatment. These trends are likely influenced by the FDA approval of intralesional injections of CCH and by the national media efforts to raise awareness of the underdiagnosed and undertreated disease.

Disclosure
No
223 Women in Medicine: Career vs Family. Can we have both?
Authors: Parikh N , Ahmed M , Robinson M , Mcgriff S , Olive E , Helo S 
Published: April 2022

ABSTRACT

Introduction
Women in healthcare are faced with unique challenges that may increase their risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age.

Objective
We sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts.

Methods
After obtaining IRB approval, a retrospective review of all hospital employees (and their partners) presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth.

Results
Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, female BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, male BMI, semen parameters and presence of male factor were noted. Live birth rate was greater in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042.

Conclusions
In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, rate of female factor infertility, use of assisted reproductive technology, or male partner factors. While no differences in fertility were noted for female health care workers in this study, further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility.

Disclosure
No
240 Cylinder Realignment for Impending Inflatable Penile Prosthesis Erosion
Authors: Osmonov D , Ragheb A , Junemann K , Wilson S 
Published: April 2022

ABSTRACT

Introduction
Due the low incidence of impending inflatable penile prosthesis (IPP) erosion, low volume implanters may be challenged by these cases. In many situations, capsule formation around the implant may suffice to hinder cylinder migration. Nevertheless, severe cases may require prompt recognition and repair otherwise will transform into infected implantations once the implant exits the skin.

Objective
In this step-by-step video we demonstrate the Mulcahy technique for distal corporoplasty and cylinder realignment performed on a case of impending left side IPP erosion. We hope this video serves as an instructive resource for treating these particular cases.

Methods
Our case was a male patient who had a previously challenging implant revision with difficult corporal dilation into severely scarred corporal bodies. This may have been the potential cause for this complication. Through a conventional penoscrotal access, we began by utilizing the cutting current to access and explant all components of the old implant. Due to the difficulty in reservoir removal, we opted to drain it and leave it in place (“Drain and retain”). In addition to the conventional instruments required for IPP implantation, the special instruments we utilized were the Wilson's backward cutting scissors as well as the Uramix cavernotomes (http://www.uramix.com/category/og/). A second small incision was performed localized at the site of presumed distal corporal perforation for access and repair of the problem. After creating the correct corporal pathway and obliterating the false track, hence concluding distal corporoplasty, a new IPP was implanted. The new reservoir was implanted ectopically, contralateral to the retained one. Although the original technique does not include device exchange and wash out, we preferred the latter to avoid the increased risk of infection associated with same device revision implantations.

Results
A new IPP was successfully implanted into the newly realigned distal corporal pathway. The patient demonstrated an eventless postoperative follow-up period. After 7 months of implant usage, the patient had a normal looking erect penis and was highly satisfied with his implant.

Conclusions
We consider the Mulcahy distal corporoplasty to be a safe and feasible approach to address the daunting complication of impending IPP cylinder erosion, excluding the need for total corporal exposure.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
122 Increasing Utilization of Outpatient Surgery for Inflatable Penile Prosthesis Placement: Contemporary Data from the National Surgical Quality Improvement Program Database
Authors: Shelton TM , Fustok J , Pandit A , Machado B , Payakachat N , Davis R , Benson C , Raheem O 
Published: April 2022

ABSTRACT

Introduction
The inflatable penile prosthesis (IPP) is the gold-standard surgical treatment for medically refractory erectile dysfunction.

Objective
The aim of this study is to characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for IPP placement while utilizing the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach.

Methods
NSQIP database was queried for men undergoing IPP placement between 2009-2019. Patients were classified as either IP (&gt;24 hours) or OP (&lt;24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications.

Results
A total of 456 patients were identified and classified: 185 as IP and 271 as OP. Statistically significant differences were noted in co-morbidities favoring inpatient surgery between the groups including chronic steroid use, chronic obstructive pulmonary disease, congestive heart failure, acute renal failure, end-stage renal disease, and bleeding disorders. Year of surgery was also significant, with a notable increase in outpatient surgery beginning in 2015 (p&lt;0.001). The 30-day complication rates between both groups differed notably for any complication (20.5 IP, 3.3% OP, p&lt; 0.001), any readmission (9.7% IP, 2.2% OP, p &lt;0.001), intraoperative or post-operative transfusion (8.1% IP, 0% OP, p&lt; 0.001), and sepsis (4.1% IP, 0% OP, p&lt;0.001). Operative time was shorter in the OP group (159.10 minutes IP, 133.50 minutes OP, p &lt;.001).

Conclusions
IPP placement is increasingly utilized as an OP procedure. OP surgery favors patients with few medical co-morbidities and shorter operative times. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward outpatient prosthetic surgery has increased.

Disclosure
No
128 Perioperative Morbidity of Penile Prosthesis Placement with Concurrent Surgery: Analysis of the National Surgical Quality Improvement Program Database
Authors: Khalil M , Acharya M , Kamel M , Davis R , Machado B , Raheem O 
Published: April 2022

ABSTRACT

Introduction
There is always a concern whether performing concurrent surgery along with penile prosthesis (PP) placement may increase the risk of complications, specifically postoperative infection. Contemporary reports on perioperative morbidity of PP placement with concurrent surgery are scarce.

Objective
To assess the 30-day postoperative morbidity in patients undergoing insertion of PP with concurrent surgery utilizing the National Surgical Quality Improvement Program (NSQIP).

Methods
From 2005-2016, the NSQIP database was queried to identify males who underwent placement of PP combined with other procedure. Patient demographics, postoperative morbidity including complications, readmission and re-operation rates were recorded and compared between the two groups. Student t test and Chi-square or Fischer's exact test were used as appropriate.

Results
142 patients were identified and included in the study. The most prevalent concurrent procedures were surgical correction of Peyronie's disease (n=54, 38%), insertion of artificial urinary sphincter (n=27, 19%), and repair of inguinal or abdominal hernia (n=25, 17.6%). A majority of patients were white (65.5%), aged 60-69 (42.9%) and received the combined procedure in 2016 (30.3%). Fifty percent of patients were ASA class I/II and 50% were class III-V. Mean body mass index (±SD) was 30.1±4.8. Mean operating time (±SD) and length of stay (±SD) were 139.4±62.7 minutes and 2.0±1.0 days, respectively. Overall, postoperative complications occurred in 7 patients (4.9%) only. Specifically, there were urinary tract infection (n=4, 2.8%), superficial surgical site infection (n=2, 1.4%) and unplanned intubation (n=1, 0.7%). Similarly, reoperation and readmission rates were low (0.7% and 2.8%, respectively).

Conclusions
Overall the 30-day postoperative morbidity, reoperation and readmission rates of PP insertion with concurrent surgery were low. The majority of the reported complications were minor. Concurrent surgery with PP insertion does not seem to significantly increase the risk of postoperative morbidity.

Disclosure
No
133 Pelvic Floor HIFEM in Men Improves Ejaculation
Authors: Brandeis J , Lu S 
Published: April 2022

ABSTRACT

Introduction
High-Intensity Focused Electromagnetic (HIFEM) field technology utilizes rapidly changing magnetic fields that generate electrical currents in the underlying tissue where it depolarizes motor neurons and causes muscle contractions. BTL Emsella provides non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of male and female incontinence. Novel protocol U2 is intended for men and uses a field intensity max of 2.5 T and a 10 cm depth of penetration for 28 minutes.

Objective
Determine the effects of High-Intensity Focused Electromagnetic (HIFEM) field technology on the intensity and duration of ejaculation in men, with additional observations on erectile function using the IIEF-15 and urination using the IPSS.

Methods
We looked at the effects of HIFEM on ejaculation, erectile function, and urination. Our IRB-approved protocol was one 28 minutes pelvic floor treatment per week for 4 weeks. At baseline, end of treatment, and one month post-treatment, the patient completed the IIEF-15, IPSS, and the LuBE Score, a four-question 5 point Likert style questionnaire created specifically for this study to investigate patient-reported aspects of orgasm, including volume, force, duration, and intensity of ejaculation. 0 is no change, 1 is increased, 2 is dramatically increased, -1 is decreased, -2 is dramatically decreased. Men participated with their sexual partners who also received four weekly treatments.

Results
12 men, average age of 57, completed the protocol. The range of the LuBE score is -8 to 8. The LuBE Score increased from baseline 0 up to 2.1 (median is 3 with a range of -1 to 5) to 2.7 (median of 3 with a range of 0 to 4) one month after the completion of treatment. The IIEF-15 increased from 54 at baseline to 60.3 at the completion of treatment and 60.4 one month after the completion of treatment. The IPSS declined from 7.1 to 4.6 at the completion of treatment and down to 3.3 one month after th

Conclusions
We conclude that the U2 protocol for HIFEM boosts the strength of the bulbocavernosus and ischiocavernosus muscle and the pelvic floor resulting in an increase in volume, force, duration and intensity of ejaculation. In addition, there was a six-point increase in IIEF-15 score. There was a 3 to 4 point drop in IPSS score. We were surprised to see improvements in IIEF-15 and IPSS, and this should be investigated further. COVID limited patient recruitment, but the results indicate that pelvic HIFEM potentially improves ejaculation. Based on patient communications, I believe that more treatments than the four provided will add to the benefits. I plan on studies with more participants and extended treatment sessions.

Disclosure
Yes, this is sponsored by industry/sponsor: BTL
Clarification: No industry support in study design or execution
Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science