bluuebunny/crossref_metadata_2025_split huggingface dataset:
93 Acceptance and Commitment Therapy to Increase Compliance to Intracavernosal Injection Use (ICI) Following Radical Prostatectomy (RP): Preliminary Results from a Randomized Control Trial
Authors: Nelson C , Tutino R , Pessin H , Joshi N , Schofield E , Mulhall J 
Published: April 2022

ABSTRACT

Introduction
ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low.

Objective
This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP.

Methods
This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner who monitors ICI use, answers questions, and provides education. The interventions are delivered over a year. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for two years. The primary outcomes are number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes are: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).

Results
To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). The mean age was 60±7 years and 81% were married. The mean erectile function grade pre-RP was 8.9±1 (0-10 scale). At 6m, the ACT group utilized more injections/week vs. the EM group (median: 2.06 vs. 1.17, p=0.01) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2).

Conclusions
Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men's satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms.

Disclosure
No
152 Effectiveness of Pudendal Nerve Blocks on Postoperative Pain Control and Reduction in Opioid Usage after Gender-affirming Vaginoplasty
Authors: Chin P. , Yuan N. , Zaliznyak M. , Stelmar J. , Garcia M. 
Published: April 2022

ABSTRACT

Introduction
Postoperative pain control in gender-affirming penile-inversion vaginoplasty (PIV) significantly affects patient experience and satisfaction. With the rise of opioid misuse and over-prescription, non-narcotic adjuncts for post-surgical analgesia are greatly needed. Currently, there is limited data on postoperative pain control after genital gender-affirming surgery (gGAS).

Objective
To evaluate the effects of preoperative pudendal nerve block on post-op patient-reported pain scores and opioid usage.

Methods
We retrospectively reviewed all trans-female patients undergoing PIV (+ creation of vaginal canal) at a single institution from August 2017 to July 2021. We recorded patient demographics, operative details, surgical-site pain (using a Likert scale 0-10; 0=no pain, 10=severe pain), and analgesic medication usage. Baseline demographics, pain scores and opioid usage were compared between patients who received pudendal nerve block preoperatively (immediately before the surgical procedure) and those who did not. Independent sample t-tests were used for all comparisons.

Results
Out of 36 consecutive patients (mean age 36.6 years, mean BMI 25.3 kg/m2) that underwent PIV, 25/36 patients did not have pre-op pudendal nerve block, while the most recent 11/36 patients did. Patient characteristics across cohorts were similar, though the 11 patients who had pudendal nerve block had higher rates of depression (54.5% vs. 28.0%, p=0.043) and hypertension (18.2% vs. 4.0%, p=0.041). Surgical-site pain scores on postop day 0 (POD0) were compared: patients who received pudendal nerve block had 35% lower pain scores than those who did not (3.09 vs. 4.74, p&lt;0.001). Surgical-site pain scores on POD5 were 10% lower in those who received pudendal nerve block (4.16 vs. 4.63, p=0.046). Although patients experienced lower subjective pain scores, average total opioid usage was similar between patients who received pudendal block (MME= 224) versus those that did not (MME= 225).

Conclusions
Our preliminary data suggests that pudendal nerve blocks are safe and effective adjuncts to improve pain control after gender-affirming PIV, thus improving patients’ postoperative experience. This modality should be further investigated and considered for routine usage in vaginoplasty, and other gGAS perioperative pain regimens. Similar opioid usage despite improved pain scores suggests that in-hospital opioid pain regimens should be more closely tailored to patient-reported pain scores.

Disclosure
No
157 An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap
Authors: Yuan N. , Gupta A. , Garcia M. 
Published: April 2022

ABSTRACT

Introduction
Peritoneal vaginoplasty (PV) has been reported for congenital and primary gender-affirming cases, but few have reported its use as secondary vaginoplasty to treat post-op neovaginal canal shortening after penile-inversion vaginoplasty (PIV). Recent adaptations of PV have been modifications of the Davydov procedure, wherein peritoneum adherent to the bladder and rectum are incorporated to line the new terminal apex of the vaginal canal.

Objective
We describe our alternative technique using a urachus-peritoneal hinge flap and discuss proposed advantages.

Methods
We performed retrospective review of all trans-female patients who underwent our PV technique for revision/salvage vaginoplasty from May 2019 to August 2020 (minimum 10 months follow-up). Patients were asked questions about their experience and satisfaction. All cases were performed via combined trans-perineal and laparoscopic (robot-assisted) approaches. Pre-op and post-op neovaginal depth/circumference were recorded. After incision and spatulation of the terminal neovagina, a midline, inferiorly based peritoneal hinge flap (minimum 8-cm width) was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The flap's free end was flipped posteriorly and sutured to the posterior edge of the open canal remnant to form a peritoneum-lined pouch. The pouch's lateral edges were sutured together, using a vaginal dilator as a guide.

Results
Five patients underwent peritoneal vaginoplasty with our technique from 5/2019 to 8/2020. Mean age was 32. All previously underwent PIV for primary vaginoplasty, with loss of neovaginal depth. Pre-op: mean neovaginal depth was 8.6 (±1.8) cm and girth was 12 cm. Immediate post-op: mean depth was 16.8 (±1.2) cm (mean net increase from pre-op: 8.2 cm) and girth was 12 cm. At mean follow-up of 1.4 years, mean depth was 12.8 (±2.4) cm (mean net increase from pre-op: 4.2 cm) and girth was 12 cm. There were no immediate complications. One patient developed anastomotic stenosis at 6 weeks post-op, managed conservatively with dilation under anesthesia. One patient stopped dilating due to a mental-health crisis and lost significant postoperative depth. Three of the 5 (60%) patients report satisfactory vaginal receptive intercourse. The other 2 have not yet attempted vaginal receptive intercourse.

Conclusions
Our PV vaginoplasty technique is a safe and effective option to treat neovaginal shortening after PIV. Advantages include no tension on peritoneal suture lines when vaginal canal is empty and total exclusion of the rectum. This technique also allows for omental interposition. We recognize the natural limited availability of peritoneum and so reserve this technique only for cases where there is adequate residual canal girth and at least 6-7 cm of residual depth.

Disclosure
No
160 Management of New Complications from Prostatic Urethral Lift
Authors: Hakky T.S. 
Published: April 2022

ABSTRACT

Introduction
Prostatic urethral lift (PUL) is a minimally invasive treatment for men with benign prostatic hypertrophy (BPH). This entails placing non-absorbable sutures with a nitinol prostate capsular anchor and a stainless-steel urethral end piece to mechanically open the intraurethral prostate for lower urinary tract symptoms (LUTS). There is a 12% incidence of complications from PUL. Here we present a single center experience with PUL along with management of the first known complication of PUL injuring the penile prosthesis reservoir and also a patient presenting with prostatic urethral adhesion following PUL.

Objective
To present the data of a single center experience with PUL and to document the first known injury of penile prosthesis reservoir from PUL and to discuss techniques and management of prostatic urethral adhesions from PUL.

Methods
A retrospective chart review was performed from the last two years of a single physician andrologic practice. Images and video was taken of the various rare complications encountered.

Results
A total of 63 PUL were performed. 1 patient had sepsis after the procedure. 2 patients had urinary retention that resolved after 7 days of catheterization. Ages ranged from 43-88 years, and prostate size ranges from 22- 90grams with a mean of 44 grams. IPSS score improved by 8 points. One patient was found to have a non-working penile implant 2 weeks after PUL. He underwent penile prosthesis revision and was found to have the PUL in the reservoir. 0 patients had retrograde or anejaculation after PUL. Three patients needed re-treatment after PUL, one opting for PUL the other opting for another modality. One patient who had PUL at another facility underwent intra-urethral prostatic stricture ligation for refractory (LUTS).

Conclusions
PUL is both safe and effective in the treatment of BPH. Caution should be taken in men with penile prosthesis and space of retzius reservoir placement as here we document the first PUL injury of the penile implant reservoir. Prostatic urethral stricture while rare can also occur and is best handled using an athermal technique to open the prostatic fossa.

Disclosure
No
163 Placement of ProACT Device in a Man with Persistent Leakage with AUS
Authors: Fish P. , Bowen A. 
Published: April 2022

ABSTRACT

Introduction
Up to 50% of men who undergo artificial urinary sphincter implantation will need a subsequent surgery within 5 years. Causes for revision include erosion, persistent leakage, urethral atrophy, infection and mechanical failure. We present a case of successful treament of recurrent SUI following AUS revision using the ProACT device. Patient was using 3 pads per day despite functional AUS.

Objective
Demonstrate technique and discuss outcome in patient treated with ProACT therapy following AUS failure.

Methods
Video with narration is used to demonstrate novel technique of using adjustable, inflatable balloons to treat post prostatectomy incontinence in a man who has experienced urethral atrophy due to in situ AUS. Pump was deactivated and small cystoscope was used to avoid damage to device. ProACT placement technique demonstrated including cystogram, flouroscopic guidance and use of specialized implantation tools.

Results
Technical description and visual demonstration of ProACT placement for a patient with persistent SUI following AUS failure. At four months post op patient was pad free without undergoing full AUS revision and associated risks.

Conclusions
ProACT may be a useful option to avoid full revision in patients with persistent or recurrent leakage following artificial urinary sphincter placement.

Disclosure
Yes, this is sponsored by industry/sponsor: Uromedica
Clarification: Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: Uromedica
164 SST and The Frozen Pump
Authors: Habashy E. , Kohler T. 
Published: April 2022

ABSTRACT

Introduction
Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during or after penile prosthesis (PP) implantation. The “frozen pump” is a phenomenon that patients experience postoperatively where they encounter difficulty inflating the device due to a rigid capsule formation around the pump leading to pump failure.

Objective
In our video we describe our surgical approach in the management of GH, and the Frankenstein technique we utilize to address a "frozen pump".

Methods
Our video demonstrates our standard technique of using permanent sutures to repair GH with bilateral distal dorsal anchoring sutures and a deep glans suture. It also demonstrates our Frankenstein pump revision technique where a different brand device component may be utilized to replace the original device pump to ease device inflation.

Results
Successful repair of GH/SST deformity and revision of a non-functioning PP pump.

Conclusions
Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP. Using different brand components to revise PP pump can be done without compromise to mechanical function.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Tobias Kohler is consultant for Coloplast
175 Could COVID-19 Induced Endothelial Dysfunction Explain New Onset Peyronie's Disease?
Authors: Rainer Q. , Saltzman R. , Premer C. , Hurwitz B. , Molina M. , Ibrahim E. , Hare J. , Ramasamy R. 
Published: April 2022

ABSTRACT

Introduction
Coronavirus Disease 2019 (COVID-19) is an emerging infectious disease caused by a novel coronavirus (SARS-CoV-2) which has been found to cause systemic inflammation in some patients. Many possible long-term sequelae of COVID-19 have yet to be identified. Since endothelial cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS2) receptors, and SARS-CoV-2 requires both receptors for cell entry, we hypothesized that widespread endothelial damage caused by COVID-19 infection leads to Peyronie's disease (PD).

Objective
New-onset PD after resolved COVID-19 infection was evaluated.

Methods
This study was performed after Institutional Review Board approval. After comprehensive history and physical exam, penile duplex was used to evaluate blood flow and characterize any plaques. International Index of Erectile Function (IIEF) was used to evaluate erectile function. Brachial artery flow-mediated dilation (FMD) and endothelial progenitor cell – colony forming units (EPC-CFU) assays were utilized as measures of endothelial function. Available data from two separate control groups were used for comparisons: “No PD” contains subjects with a history of cardiovascular disease and normal erectile function according to IIEF-EF score (n=27). This group was selected to serve as a negative control with endothelial dysfunction. A second control group “Healthy Controls” was selected as a positive control containing male participants who were free from any significant cardiovascular medical history (n=9).

Results
New-onset PD after resolution of COVID-19 infection was identified in one patient. The penile duplex with erectogenic agents demonstrated normal vascular flow with presence of calcified plaques. The PD group median EPC-CFU levels were 0 as compared to 1.60 in the no PD (negative control) group and 20.00 in healthy (positive) controls. Similarly, median FMD% was impaired in the PD group (2.35%) and no PD group (3.88%) as compared to healthy controls (7.75%).

Conclusions
These findings reveal a novel mechanism for PD after resolution of COVID-19 infection. These findings have significant clinical and biological implications for males with PD and should be considered as a possible sequela of COVID-19 infection.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus Pharmaceuticals, Boston Scientific, Coloplast, Endo Pharmaceuticals, Empower Pharmacy, Nestle Health, Olympus
181 Perioperative Morbidity of Feminizing Gender Affirmation Surgery: Analysis of the National Surgical Quality Improvement Program (NSQIP) Database
Authors: Walton A. , Pandit A. , Payakachat N. , Mundinger G. , Raheem O. , Benson C. 
Published: April 2022

ABSTRACT

Introduction
Genital Gender Affirmation Surgery (gGAS) has become increasingly prevalent as a result of increasing insurance coverage and surgeon availability throughout the US.

Objective
To characterize the demographics, trends, and perioperative morbidity of feminizing gGAS among transgender patients in the US using a population data.

Methods
The National Surgical Quality Improvement Program (NSQIP) database was queried to perform retrospective analysis of feminizing gGAS between 2006-2019. Due to a lack of standardized CPT codes for feminizing gGAS, we identified our initial cohort using individual common CPT codes for gGAS, associated with ICD Codes for gender dysphoria. We further differentiated primary gGAS from revision cases by requiring penectomy (CPT 54120/54125) and one vaginoplasty code (CPT 57291, 57291, 57335, 55970) to be included. We characterized baseline demographics, perioperative characteristics, and 30-day complications.

Results
141 transgender patients underwent feminizing gGAS from 2016-2019, after excluding 285 patients, as none were documented before 2016. The majority of cases were in 2018 (n=57, 40.4%) and 2019 (n=41, 29.1%). Most patients were operated on by plastic surgery (85%), compared to urology (15%). Mean age was 39.6 years (SD=13.8), and mean BMI was 26.3 (SD=5.5). Gender was classified as female (77.3%), male (22.7%) and non-binary (0.7%). 78% were white, 7.8% African American, 7.1% Asian, and 7.1% other. The most common co-morbidities were hypertension (7.8%), diabetes (6.4%), and smoking (5%). The mean operative time was 339 min (SD=85.7min) and mean hospitalization was 6.1 days (range 3-24 days). There were 14.6% with ³1 complication (14.6%). Wound disruption occurred in 12 patients (8.5%), 4 (2.8%) UTIs, 3 (2.1%) superficial wound infections and 1 (0.7%) deep wound infections, and 3 (2.1%) required blood transfusion. Among 12 patients (8.5%) that returned to OR (average of 12.6 days), 50% for wound disruption and 6 patients were readmitted at mean 19.4 days from surgery.

Conclusions
This is the first characterization of patients undergoing femininizing gGAS utilizing the NSQIP database. There continues to be increasing volume of patients undergoing primary gGAS, which appears to be safe with acceptable rates of complications and reoperations. Further study utilizing claims-based population databases may provide a better understanding of the scope of feminizing gGAS.

Disclosure
No
185 Preventing Urinary Fistulae After Artificial Urinary Sphincter Removal: Outcomes of a Standardized Protocol
Authors: Lin J. , Ginsberg D. , Doumanian L. , Boyd S. , Loh-Doyle J. 
Published: April 2022

ABSTRACT

Introduction
The artificial urinary sphincter (AUS) is the standard treatment for moderate to severe stress urinary incontinence in male patients. Despite their efficacy, the AUS is not without risk. Patients with an AUS are susceptible to complications such as mechanical failure, device infection, and urethral erosion. Erosion of the urethra can result in negative sequelae such as urethral stricture disease and urinary fistulae.

Objective
While there is no debate that patients presenting with urethral erosion require removal of the AUS, there is a lack of consensus on how to manage the patient in the perioperative period. We present our experience using a standardized surgical technique and perioperative protocol used at our institution to manage patients with an AUS presenting with urethral erosion.

Methods
Using an IRB-approved prosthetic database we completed a retrospective review of 97 patients who underwent AUS explantation between 2009 and 2020. Indications for removal, patient demographics, AUS component characteristics, and post-operative outcomes were analyzed. Patients undergoing AUS removal in the setting of urethral erosion were treated with a standardized protocol. Upon presentation, cystourethroscopy is performed to confirm erosion and to facilitate safe passage of a urethral catheter. With the urethral catheter in place, all AUS components are removed. After urethral cuff removal, urethrorraphy is performed. A 10-French surgical drain is placed through a separate stab incision and made to lie in the perineum and the wounds are closed in multiple layers. The urethral catheter is left in place for 4 weeks. After 4 weeks, physical examination and cystourethroscopy is performed to confirm repair of the urethra and the absence of fistula. Patients are seen monthly and are deemed eligible for reimplantation only after a minimum of 3 months have elapsed after explantation and the patient is deemed to have sufficient healthy urethra.

Results
No intraoperative complications occurred during AUS explantation. 117 patients underwent AUS removal during the study period. 94 (80.3%) patients had AUS removal due to urethral erosion. After median follow-up of 18.1 months (IQR 6.5 – 48.2) after AUS removal, there were a total 6 (4.0%) patients who developed a urethrocutaneous fistula with median time from AUS removal to fistula resolution of 6.5 months. Each patient with fistulae had presented with erosion of the urethra as indication for AUS removal. 67 (57.3%) patients underwent successful AUS reimplantation after removal with median time between explant and reimplant of 3.5 months (IQR3-4.8). Risk factors for urinary fistulae include urethral erosion, prior treatment with pelvic radiotherapy, and increasing age at time of AUS removal.

Conclusions
Urinary fistula can be prevented after urethral erosion with standardized surgical technique and peri-operative management in patients with an AUS.

Disclosure
No