MP48-15 TESTOSTERONE PELLET IMPLANTATION PRACTICES AMONG MEMBERS OF THE SEXUAL MEDICINE SOCIETY OF NORTH AMERICA (SMSNA)

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy1 Apr 2016MP48-15 TESTOSTERONE PELLET IMPLANTATION PRACTICES AMONG MEMBERS OF THE SEXUAL MEDICINE SOCIETY OF NORTH AMERICA (SMSNA) Brijesh Patel, Michael Piecuch, Run Wang, Lawrence Hakim, and Hossein Sadeghi-Nejad Brijesh PatelBrijesh Patel More articles by this author , Michael PiecuchMichael Piecuch More articles by this author , Run WangRun Wang More articles by this author , Lawrence HakimLawrence Hakim More articles by this author , and Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.355AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Manufacturers recommend using 6 testosterone pellets for the initial management of adult-onset hypogonadism. These guidelines are based upon pharmacokinetic studies of a chemically similar drug currently not approved by the FDA. Several studies demonstrate that this initial dosing may produce an insufficient rise in testosterone (T) along with inadequate relief of hypo-androgenic symptoms. METHODS A 19-item survey evaluating testosterone pellet implantation was electronically distributed to 687 members of the SMSNA. RESULTS 87 survey responses were received (12.9%). 32 (36.8%) practitioners started therapy when testosterone (T) range was 250-300 ng/dL. After the first implantation, 81 (93.1%) reported T levels >400 ng/dL, while 39 (44.8%) reported T levels over 600 ng/dL. At the time of initial implantation, 70 (80.5%) placed 10 or more pellets, while only 4 (4.6%) placed 6-7 pellets. Baseline T levels and BMI were the most commonly used metrics for initial dosing. 63 (72.4%) checked T levels one month after implantation. In the majority of patients, subsequent dosing of T pellets remained unchanged. The “V” and stacked techniques for pellet insertion, were used by 64 (74.7%) and 22 (25.6%) respectively. 62 (72.1%) closed the incision with steri-strips, 18 (20.9%) used stitches, and 6 (7%) used a combination. Hematoma formation was observed “very occasionally” or “never” by 61 (70.9%) and 12 (14%) implanters respectively. Similarly, pellet extrusion was observed “very occasionally” or “never” by 61 (70.9%) and 23 (26.7%) respectively. 57 (65.5%) reported that their patients underwent re-implantation 3-4 months after the initial procedure (range 1 - 6 months). 47 (54.0%) only “very occasionally” and 20 (23.0%) “never” used supplemental testosterone formulations ([2 (48.3%) used cutaneous testosterone gels, while 23 (26.4%) used testosterone injections]. 49 (56.3%) respondents found their patients to be satisfied “most times” and 30 (34.5%) said their patients are “almost always” satisfied with Testopel therapy. When discontinued, cost was cited as the most common reason. CONCLUSIONS Contrary to manufacturer recommendations, this survey indicates that the vast majority of specialists commonly use >=10 pellets at initial implantation. This dosing schedule appears to be linked to higher rates of eugonadal T levels one month post-implantation, and requires infrequent adjustment in dosing on subsequent implantations. The majority of urologists in this survey found their patients to be highly satisfied with testosterone pellet implantation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e641 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brijesh Patel More articles by this author Michael Piecuch More articles by this author Run Wang More articles by this author Lawrence Hakim More articles by this author Hossein Sadeghi-Nejad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...