bluuebunny/crossref_metadata_2025_split huggingface dataset:
212 New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications
Authors: Wu S , Swanton A , Gross M 
Published: April 2022

ABSTRACT

Introduction
Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. Registered Nurse First Assistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant.

Objective
Comparing the influence of different assistants on perioperative complications of Inflatable Penile Prosthesis

Methods
Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. A logistic regression model was used to identify predictors of complications. Student's T test was used to examine for differences in total OR time between different assistants.

Results
A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 – 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs 72.9 ± 35.5 min, p&lt;0.01). Patient factors including new IPP, BMI&gt;30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 – 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively.

Conclusions
Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
233 “Dipping Time” for Irrisept Solution on Titan Inflatable Penile Prosthesis Hydrophilic Coating: No Difference From 1 to 60 minutes
Authors: Karpman E , Klous D , Zhang W , Taylor J , Henry G 
Published: April 2022

ABSTRACT

Introduction
Since hydrophilic coated penile prostheses (PP) first came out, people have discussed how long should the PP be submerged in whatever solution the surgeon decided to “dip” the implant into hoping for the solution to absorb onto the coating of the PP. There has been much discussion and several studies on different antimicrobial agents to soak the Titan PP into. Irrisept is FDA approved to irrigate surgical wounds and company statements appear to show that 99.9% of bacteria and fungus are covered by the solution.

Objective
For the first time in the known literature, we evaluate dipping time of the hydrophilic coating of the Titan PP.

Methods
The Titan PP was soaked in Irrisept solution or normal saline for 1, 15, 30 and 60 minutes. All parts were placed in a 35°C oven for 15 minutes to dry before Congo Red Dye test. Congo Red Dye testing was performed per test method VV-0199713, which is the approved FDA test for ensuring product reliability. The testing was done by an independent third company.

Results
There was no noticeable effect or difference of coating adherence between different soaking times for Irrisept solution or normal saline. Pre-connected IPP products including both pumps and cylinders were tested. (Figure 1 Congo Red stain)

Conclusions
There appears to be no difference in soaking time from 1, 15, 30 or 60 minutes for Irrisept solution or normal saline. Biocompatibility and long-term device performance have not been verified using the Irrisept solution.

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
235 Penile Invagination and Corporal Excavation for Penile Prosthesis Placement in Severe Corporal Fibrosis
Authors: Kim C , Campbell S , Allkanjari A , Barton G , Lentz A 
Published: April 2022

ABSTRACT

Introduction
The penile prosthesis is a standard treatment for men with erectile dysfunction refractory to vacuum, medical, or injection therapies. In patients with virgin tissue planes and normal anatomy, prosthesis placement can be technically straight forward and associated with minimal morbidity. Patients with corporal fibrosis present a unique surgical challenge for implantation and there is no standardized approach to care. Selection of the appropriate surgical technique can vary depending on the extent of corporal fibrosis and surgeon experience. In this case, our patient's corporal fibrosis resulted from two episodes of prolonged priapism as well as two distal shunts and a failed attempt at inflatable penile prosthesis placement resulting in a prolonged wound infection.

Objective
We present our unique surgical approach for penile prosthesis implantation in the most severe cases of corporal fibrosis.

Methods
Video demonstration of corporal excavation and penile prosthesis placement via a perineal incision with complete penile invagination.

Results
Comprehensive pre-operative planning guided our decision to utilize a malleable prosthesis given the severe degree of corporal fibrosis and higher risk of complications with a three-piece IPP. Our penile invagination technique allowed us to achieve complete longitudinal corporal exposure while avoiding multiple incisions or overlapping incisions near the corporotomy and cylinders. Tachosil or other biologic grafts should be available for use in cases where primary corporotomy closure is not possible.

Conclusions
We demonstrated that penile invagination, corporal excavation, and implantation with a malleable prosthesis is a safe and effective treatment for patients with the most severe corporal fibrosis.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific
239 The Tunneling Technique: A Universal Approach for Salvage Penile Prosthetic Implantation in Severely Scarred Corporal Bodies
Authors: Osmonov D , Ragheb A , Junemann K , Wilson S 
Published: April 2022

ABSTRACT

Introduction
IPP implantation in severe cases of intracorporal scarring poses a daunting challenge, even to experts in the field, owing to associated difficulty and high rates of complications.

Objective
In a step-by-step video, we demonstrate the successful implantation of an IPP in a case of total intracorporal fibrosis utilizing the tunneling technique through the subcoronal approach. We aspire this video to serve as an instructive resource for treating these special cases.

Methods
We present our approach performed on a 32 year old African male patient suffering complete intracorporal fibrosis as a result of a full week episode of ischemic priapism due to sickle cell anemia. The penile shaft was degloved via a subcoronal incision. In addition to the conventional instruments required for IPP implantation, for tunneling and dilation, we used the Wilson's backward cutting scissors, the Uramix original cavernotomes (http://www.uramix.com/category/og/), the Carrion-Rossello cavernotomes (https://www.coloplast.co.uk/rossello-en-gb.aspx), and the Zephyr cavernotomes. Apart from the unique corporal dilation steps, IPP implantation was performed in the classic fashion. A closed suction drain was utilized as part of our routine protocol. Our patient was followed up the patient for one month on a weekly basis then again after 3 months.

Results
After successful corporal tunneling utilizing our special instruments we were able to seamlessly implant a size 20 Coloplast Narrow-Base Titan Touch prosthesis with 2 cm rear tips on both sides. The patient demonstrated an eventless postoperative follow-up period for up to 3 months and was highly satisfied with his implant.

Conclusions
We believe that corporal tunneling via the subcoronal approach may be both a successful and universal option for cases of severe intracorporal fibrosis provided both adequate surgeon experience and special instruments were available. It is a minimally invasive approach excluding the need for corporal reconstruction and utilization of additional grafting thus lowering the risk of postimplantation infection.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
245 Penuma® Concealed Surgery Technique Featuring A New Scrotal Incision
Authors: Elist J , Wilson S , Tajkarimi K , Levine L , Valenzuela R , Blick S 
Published: April 2022

ABSTRACT

Introduction
Innovation in surgical techniques can lead to enhanced patient outcomes and increased efficiency. Penuma®, a silicone penile sleeve implant used for cosmetic enhancement of the penis, has traditionally been inserted through an infrapubic incision. Recently, a new scrotal incision method for silicone penile sleeve implantation has been developed named the “concealed” technique. Compared to the traditional infrapubic entry point, a longitudinal 1-2 cm incision is made to the left or right lateral base of the penis on the scrotum. Aside from the incision location, the remainder of the procedure mirrors that of the traditional suprapubic technique.

Objective
The purpose of this video is to demonstrate the “concealed” technique with the insertion of the Penuma® implant through a scrotal incision.

Methods
Multiple prosthetic urologists have conducted the Penuma® insertion procedure, employing the “concealed” technique. The technique is demonstrated and narrated in the video. Patients were followed post-operatively for at least three months following the procedure to help identify the benefits of the “concealed” technique versus the traditional infrapubic approach.

Results
Various benefits have been observed using this technique. The first benefit is the lack of a visible incision. After three months of healing, the resultant scar appears hidden by the scrotal rugae giving the appearance that no procedure had taken place. Secondly, the procedure time has been reduced by an average of 10 minutes. Third, there appears to be less retraction of the penis immediately after the procedure. With the traditional suprapubic entry point, the placement of closing sutures may cause scar contraction and tightness leading to temporary retraction in flaccid size immediately after the procedure. Comparatively, the “concealed” method utilizes a scrotal incision line, which allows the suprapubic and abdominal skin to remain not incised, leading to immediate penile skin expansion without the initial, temporary retraction. Finally, post-operatively, the concealed technique has led to a lowered likelihood of seroma formation due to no abdominal wall dissection. This has led to decreased swelling and fluid accumulation. Consequently, this has also led to less reliance on the surgical drain (1-2 days vs. 3-4 days with the tradition technique).

Conclusions
The new scrotal approach named the “concealed” technique appears to be a simpler, quicker, and more aesthetically favorable alternative to the traditional suprapubic approach. The “concealed” technique is especially ideal in cosmetic surgery where peno-centric patients are focused on penile appearance. Physicians employing the use of the scrotal incision seem to agree that there is a lessened chance of seroma formation, simpler post-operative care, and favorable immediate results. Further evaluation must be conducted to identify additional benefits, but the initial benefits appear to be very promising.

Disclosure
No
103 Testicular Microlithiasis Defines a Subgroup of Azoospermic Men with Low Rates of Sperm Retrieval
Authors: Dekalo S , Barda S , Pignanelli M , Campbell J 
Published: April 2022

ABSTRACT

Introduction
Testicular microlithiasis is prevalent in sub-fertile men but data regarding its association with sperm retrieval rates in azoospermic men are lacking.

Objective
To investigate the prevalence of testicular microlithiasis and its relationship with sperm retrieval rates and histopathology in azoospermic men.

Methods
Eighty-six consecutive men underwent scrotal ultrasonography prior to microsurgical testicular sperm extraction (microTESE). Sperm retrieval rate, testicular histopathology, testicular size, reproductive hormone estimation, karyotyping, Y chromosome microdeletion analyses and the presence of varicocele and hydrocele were compared between men with and without testicular microlithiasis.

Results
In total, sperm retrieval rate was 40%. Testicular microlithiasis was detected in 12 men (14%). In this subgroup, sperm retrieval rate was only 8% (1/12) as opposed to 45% (33/74) in azoospermic men with no evidence of microlithiasis (p=0.02). Mean right and left testicular diameters were significantly lower in the microlithiasis group compared to men without microlithiasis (2.4 cm vs. 3.2 cm and 2.4 cm vs. 3.3 cm, respectively, p=0.04). There was no significant difference in any other parameter between the groups (age, FSH levels, prevalence of XXY karyotype, Y chromosome microdeletions, sonographic varicoceles or hydroceles). All eleven patients with microlithiasis and no spermatozoa found were diagnosed with Sertoli cells only on histopathology. The patient with testicular microlithiasis and successful sperm extraction was diagnosed with mixed atrophy.

Conclusions
Among our cohort of azoospermic men who underwent scrotal ultrasound prior to microTESE, the presence of testicular microlithiasis was associated with very low sperm retrieval rates. Larger, prospective studies should be conducted to strengthen our results.

Disclosure
No
106 Premenstrual Dysphoric Disorder on Youtube: a Quality Analysis
Authors: Kyarunts M 
Published: April 2022

ABSTRACT

Introduction
Watching videos on YouTube™ (http://www.youtube.com) to learn about diseases and treatments is becoming more popular.

Objective
This cross-sectional study evaluated the quality of YouTube™ videos on Premenstrual Dysphoric Disorder (PMDD).

Methods
YouTube™ was searched for “premenstrual dysphoric disorder” and the fifty most viewed videos were analyzed. Three quality measures were used: Global Quality Scores, JAMA benchmark, and DISCERN. Other features recorded included video duration, views, likes, dislikes, and subscribers. Spearman correlation was calculated to understand the relationship between quality and those features. Source of upload, target audience, distinction between PMS and PMDD, and inclusion of Diagnostic and Statistical Manual 5 (DSM-5) criteria of PMDD were recorded.

Results
The fifty videos had 2,004,266 views. No statistically significant associations were found between video quality and other features. Mean JAMA, GQS, and DISCERN were 1.96/4 (SD=0.45), 2.26/5 (0.94), and 29.5/80 (8.2), respectively. The majority (48%) of videos described symptoms and treatment. 14% gave DSM-5 for PMDD. The target audience were patients for 82%. The common sources of upload were individual users (34%), professional organizations (16%), healthcare professionals (12%), and academic organizations (10%). 20% mentioned the importance of tracking symptoms in a menstrual diary. 28% distinguished PMDD from Premenstrual Syndrome (PMS). 30% of the videos included personal narratives, 20% included descriptions from medical doctors, and 12% included both.

Conclusions
The overall quality of the videos is poor based on the three measures. Since the quality of videos remains unregulated and they are easily accessible, inaccurate information can be disseminated quickly. The study revealed a need for more objective biopsychosocial information on the diagnosis, clinical presentation, and treatment options on the video platform. Currently, healthcare professionals and academic institutions post only a minority of videos. To increase credible information, healthcare professionals and academic organizations can increase the number and quality of videos they make for YouTube™.

Disclosure
No
110 Acne, Folliculitis and Post-Operative Infection Rates of Penile Prosthetic Implants
Authors: Choi E , Barnard J , Horns J , Paudel N , Das R , Yafi F , Hotaling J 
Published: April 2022

ABSTRACT

Introduction
Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined.

Objective
In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI).

Methods
The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant.

Results
Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p&lt;0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b).

Conclusions
There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome
124 Immediate Salvage with Inflatable Penile Prosthesis in an Infected Field: A Contemporary Multi-institutional Cohort
Authors: Jiang D , Barnard J , Choi E , Furr J , Lentz A , van Renterghem K , Selph P , Yafi FA 
Published: April 2022

ABSTRACT

Introduction
Contemporary management of inflatable penile prosthesis (IPP) infections involves removal and replacement to minimize corporal fibrosis and penile shortening. Many urologists prefer a malleable prosthesis (MP) followed by staged conversion to IPP, a technique thought to improve outcomes by allowing treatment of the infection while maintaining intracorporeal volume. A staged procedure involves additional surgery with associated risks. Previous studies suggest an 18% infection risk of placing a second device in a non-infected, revision setting, and that infection risk increases with each subsequent procedure.

Objective
Our study aims to delineate whether immediate IPP salvage in an infected field yields similar complication rates to the staged approach.

Methods
Retrospective review at 5 different institutions from February 2010 to October 2020 identified patients with IPP infection who underwent IPP salvage. Patient demographic, laboratory, operative, and microbiology data were collected. Emphasis was placed on the salvage operative technique, duration of antibiotics, and post-salvage complications.

Results
Overall, 19 patients underwent immediate salvage with IPP in the setting of a suspected infection. Average age at initial implantation was 59.9 years. Median time from initial implant to presentation with infectious symptoms was 2.4 months, and revision was performed a median of 1.5 days after presentation and initiation of antibiotics. Intraoperative complications were rare (5.3%), and post-salvage complications were 21.1%, including 1 cylinder herniation and 3 post salvage infections (15.8%). Only 1 post-salvage infection showed concordance with initial cultures while 1 was discordant and the third showed no growth (Table 1). Fisher's exact test showed diabetes, purulence in the operative field, use of drain, or washout type were not associated with infection post-salvage.

Conclusions
Immediate IPP salvage in the setting of an acutely infected field shows a complication profile not exceeding published data in the staged revision setting. Although staged MP-IPP salvage has been favored by many surgeons, the complication profile may be equivalent to immediate IPP salvage, and the risks of a subsequent operation should be considered.

Disclosure
No