Complications In Men Research Articles

Sex differences in shocks and device-related complications in subcutaneous implantable-cardioverter defibrillator patients

Abstract Background The use of implantable cardioverter-defibrillators (ICDs) improves the life expectancy of patients at risk of sudden cardiac death. However, ICD treatment comes with the risk of device-related complications. As the lead is the Achilles heel of the transvenous ICD (TV-ICD), the subcutaneous ICD (S-ICD) was developed to overcome the risk of lead-related complications. It is reported for TV-ICDs that women receive less appropriate therapy, but are more likely to experience ICD-related complications than men. It is unclear whether these differences also exist among S-ICD recipients. Purpose This study investigates the differences in appropriate shocks (AS) and device-related complications in men and women implanted with an S-ICD. Methods Retrospective data was collected of all patients implanted with an S-ICD between 2009 and 2022 in our tertiary center. Propensity score matching was used to create two comparable groups that differed by sex. The numbers of patients with an AS and device related-complication requiring intervention were compared between men and women. Differences between the groups were tested using a Fisher’s exact or X2-test. Results A total of 108 men and 108 women were included in this analysis. The median age was 40 years in men and 41 years in women (p=0.747), 61% had a primary prevention indication, and the median follow-up duration was 8 years. AS were seen in 15 women versus 24 men (p=0.156). There were 6 women versus 12 men with a device-related complication requiring intervention (p=0.218) (figure). The most common complication in men was infection (4/12) whereas in women erosion of the pocket occurred most frequently (2/6). Conclusions In this study, there was no significant difference in the number of patients with AS or complication between men and women with an S-ICD. However, a trend was seen towards more shocks and complications in men. The S-ICD may be a more suitable device for women, but further research with a larger sample size is needed.sex differences in S-ICD recipients

Sex/gender differences in spontaneous reports to a French Addictovigilance centre.

To specify psychoactive substances and related complications observed in spontaneous reports (SRs) in women versus men, we assessed SRs on substance-linked acute toxicity sent to a French Addictovigilance centre. Over the period 2021-2022, 880 SRs were analysed (33.4% concerned women). Severe complications concerned more men than women (70.3% versus 59.5%; p = 0.0014). In women, the main implicated substances were psychoactive medications (opioids, benzodiazepines). The most frequently reported complication was suicidal behaviour (14.6% versus 7.8%, p = 0.002). In men, SRs concerned mainly illicit substances (cocaine, amphetamines) or misuse of opioid maintenance therapy or nitrous oxide. The main complications in men were infections (12.97% versus 5.4%, p = 0.0006) and neurological troubles (37.6% versus 23.5%, p < 0.0001).Our data highlight sex/gender disparities in substance use and complications, in agreement with recent literature and French national Addictovigilance data.

Remdesivir-Related Cardiac Adverse Effects in COVID-19 Patients: A Case-Control Study.

There have been reports of serious side effects of Remdesivir, including cardiovascular complications. The present study aimed to determine the adverse cardiovascular effects of Remdesivir and the factors affecting them in COVID-19 patients. The patients were classified into two groups: those receiving Remdesivir without cardiac complications and those receiving Remdesivir with cardiovascular complications. After reviewing the patient's medical records, the relationship of some factors with the incidence of adverse cardiovascular effects was measured. Chi-square test showed that the distribution of complications in men was significantly higher than in women (P=0.001). The independent t-test revealed that the mean age in the group with complications was significantly higher than the group without complications (P=0.013). Fisher's exact test demonstrated a significant relationship between smoking and cardiovascular complications (P=0.05). According to the Mann-Whitney test, a significant difference was found in the mean changes of Bilirubin (P=0.02) and ALKP (P=0.01) before and after treatment in the groups with and without heart complications. Our findings indicated that most of the COVID-19 patients suffered from sinus bradycardia, and the distribution of complications was more pronounced in men than in women. The mean age in the group with complications was higher than the group without complications. Smoking was found to be associated with the occurrence of cardiovascular complications and the mean changes of Bilirubin and ALKP before and after treatment were significantly different in the groups with and without cardiovascular complications.

1333-P: A Mutation Causing Glucose-6-Phosphate Dehydrogenase Deficiency Increases the Risk of Diabetes Complications in Men with African Ancestry

1333-P: A Mutation Causing Glucose-6-Phosphate Dehydrogenase Deficiency Increases the Risk of Diabetes Complications in Men with African Ancestry

(103) Prior Intracavernosal Injection Therapy and Prostate Cancer Treatment are Both Independently Associated with Increased Risks of Complications in Men Undergoing Inflatable Penile Prosthesis Placement

Abstract Introduction Intracavernosal injection (ICI) therapy for erectile dysfunction (ED) carries a risk of corporal fibrosis, potentially making placement of an inflatable penile prosthesis more difficult. Prostate cancer treatment may also induce corporal fibrosis. Objective To assess whether a history of ICI or prostate cancer treatment is associated with complications following IPP placement. Methods A retrospective cohort study of primary IPP cases from 2016–2021 across 16 institutions. Patients were stratified by history of ICI and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications, postoperative non-infectious complications and postoperative infection. Results A total of 2540 patients met inclusion criteria of which 781 (30.8%) had a history of ICI. Patients with a history of ICI tended to be older (mean 63 vs 64 years, p=0.002) and were more likely to have history of radical prostatectomy (21.0% vs. 32.1%, p&amp;lt;0.001) and/or radiation (5.51% vs 10.9%, p&amp;lt;0.001). On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, p=0.03; OR 2.27, p=0.03; OR 2.40, p=0.04, respectively). A history of ICI and patient age were predictors of non-infectious postoperative complications (OR 1.44, p=0.02, OR 1.02, p=0.004 respectively)). None of the variables were significant predictors of infection. Conclusions In men undergoing IPP placement, a history of ICI is associated with an increased risk of both intraoperative and postoperative, non-infectious complications. Prostate cancer treatment with radiation or surgery is independently associated with increased risk of intraoperative complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: D.O. has served as a consultant for Coloplast, Intuitive Surgical, and Fidelis. P.P. has served as a consultant for Coloplast, Boston Scientific, and Urofill. M.S. has served as a consultant for Boston Scientific and Coloplast. J.S. has served as a consultant for Boston Scientific and Coloplast. F.A.Y. has served as a consultant for Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, and Acerus Pharma. M.S.G. has served as a consultant for Coloplast. The other authors disclose no conflicts.

(176) Prior Intracavernosal Injection Therapy and Prostate Cancer Treatment are Both Independently Associated with Increased Risks of Complications in Men Undergoing Inflatable Penile Prosthesis Placement

Abstract Introduction Intracavernosal injection (ICI) therapy for erectile dysfunction (ED) carries a risk of corporal fibrosis, potentially making placement of an inflatable penile prosthesis more difficult. Prostate cancer treatment may also induce corporal fibrosis. Objective To assess whether a history of ICI or prostate cancer treatment is associated with complications following IPP placement. Methods A retrospective cohort study of primary IPP cases from 2016-2021 across 16 institutions. Patients were stratified by history of ICI and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications, postoperative non-infectious complications and postoperative infection. Results A total of 2540 patients met inclusion criteria of which 781 (30.8%) had a history of ICI. Patients with a history of ICI tended to be older (mean 63 vs 64 years, p=0.002) and were more likely to have history of radical prostatectomy (21.0% vs. 32.1%, p&amp;lt;0.001) and/or radiation (5.51% vs 10.9%, p&amp;lt;0.001). On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, p=0.03; OR 2.27, p=0.03; OR 2.40, p=0.04, respectively). A history of ICI and patient age were predictors of non-infectious postoperative complications (OR 1.44, p=0.02, OR 1.02, p=0.004 respectively)). None of the variables were significant predictors of infection. Conclusions In men undergoing IPP placement, a history of ICI is associated with an increased risk of both intraoperative and postoperative, non-infectious complications. Prostate cancer treatment with radiation or surgery is independently associated with increased risk of intraoperative complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: D.O. has served as a consultant for Coloplast, Intuitive Surgical, and Fidelis. P.P. has served as a consultant for Coloplast, Boston Scientific, and Urofill. M.S. has served as a consultant for Boston Scientific and Coloplast. J.S. has served as a consultant for Boston Scientific and Coloplast. F.A.Y. has served as a consultant for Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, and Acerus Pharma. M.S.G. has served as a consultant for Coloplast. The other authors disclose no conflicts.

Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.

Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. Study participants were 26,673 diabetic men who received health check-up both in 2003-2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003-2004 and 2009, changes in smoking status were categorised into 7 groups (never - never, never - quitting, never - current, quitting-quitting, quitting-current, current-quitting and current-current). Smoking amount was categorised into never, light (0-10 pack years), moderate (10-20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed-up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. Current-quitting (1.271 [1.050-1.538]), current-current (1.243 [1.070-1.444]) and heavy smoking (1.238 [1.078-1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current-current smoking (1.429 [1.098-1.860]) and heavy smoking (1.357 [1.061-1.734]). An increased risk of neuropathy was observed in current-quitting smoking (1.360 [1.076-1.719]), current-current smoking (1.237 [1.025-1.492]) and heavy smoking (1.246 [1.048-1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients.

Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty

IntroductionTotal hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA.MethodsData from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28.ResultsThere was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA.ConclusionPerioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.

(247) Complication Rates After Penile Prostheses In Men with History of Priapism – A Retrospective Claims Database Cohort Analysis

Abstract Introduction Penile prostheses can be placed in men with a history of priapism who develop erectile dysfunction, or as initial management of acute ischemic priapism. However, little is known about long-term complications associated with prostheses in these men. Objective To assess the risk of penile prosthesis complications in men with a history of priapism. Methods We searched the TriNetX insurance claims database to create a cohort of men ages ≥16 years old with 1) a diagnosis of priapism (ICD-10: N48.4), 2) a diagnosis of erectile dysfunction (ICD-10: N52), and 3) had undergone prosthesis placement (insertion of penile prosthesis inflatable and self-contained [CPT: 54401], insertion of semi-rigid penile prosthesis [CPT 54400], or insertion of multiple component inflatable penile prosthesis [CPT: 54405]). Three complications were assessed: penile prosthesis infection (ICD-10: T83.61), penile prosthesis mechanical breakdown (ICD-10: T83.410A), and penile prosthesis displacement or migration (ICD-10: T83.420). Rates of and duration to IPP removal (CPT: 54415-17, 54406, 54410-11) were also assessed. To compare rates of complications, the priapism cohort was compared to a cohort of men with a diagnosis of erectile dysfunction and prosthesis placement but without a history of priapism or corpora cavernosal irrigation, matched by age, race, diabetes status, and obesity (E66). When assessing risk of prosthesis complications, we utilized 1:1 greedy nearest-neighbor propensity score matching to control for confounding variables. Results A total of 665 men were identified with a diagnosis of priapism and erectile dysfunction who subsequently received a penile prosthesis. A control group of 31,345 patients with erectile dysfunction and a penile prosthesis but without priapism or history of irrigation was identified, and ultimately 660 men in the case and control cohorts were matched by age, race, diabetes status, and obesity. Men of with a history of priapism were more likely to experience penile prosthesis infection (5.0% vs 2.7%; Risk Ratio (RR): 1.83, 95% Confidence Interval (CI) 1.04-3.22) and mechanical breakdown of the prosthesis (7.3% vs 3.8%, RR: 1.92, 95%CI 1.20-3.08). There was no difference in the rate of penile prosthesis displacement or migration (3.5% vs 2.4%, RR: 0.76, 95%CI 0.77-2.70). Overall rates of penile prosthesis explantation were higher in men with a history of priapism 14.6% vs 8.4% (RR: 1.73, 95%CI 1.27-2.36). Rates of early explantation (within 6 months of placement) were similar between the two groups, 3.3% vs 2.9% (RR: 1.16, 95%CI 0.63-2.11). Rate of explantation of semi-rigid prostheses were significantly higher in men with a history of priapism, 27% vs 9.6% (RR: 2.54, 95%CI 1.62-3.93). Of the 17 men undergoing explantation of semi-rigid prosthesis with history of priapism, only 4 men (23%) went on to have a 3-piece penile prosthesis placed. Conclusions In this US claims-based database comparison between prosthetic complications in men with and without a history of priapism, men with priapism were more likely to experience infection, mechanical breakdown and explantation. There was no difference in rate of device displacement or migration, or in timing of device explantation. This real-world data provides context for counseling men with priapism who undergo prosthesis placement. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Urogen Pharma, Janssen Global Services, Regeneron Pharmaceuticals

(421) Partial versus Complete Component Exchange in Revision of the Non-Infected Inflatable Penile Prosthesis: A Multicenter Analysis.

Abstract Introduction Management of malfunctioning inflatable penile prostheses (IPPs) is varied, with some patients undergoing complete exchange of the entire device and others undergoing exchange of non-functioning components only. The impact of partial component exchange versus complete device exchange on infectious and non-infectious complications is unknown. Objective To describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction. Methods We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components (i.e. pump revision only, or pump and/or reservoir exchanged but cylinders left in situ). Differences between baseline demographics were assessed with two tailed student t-tests and Fisher’s exact tests. Time to revision was log transformed to reduce deviation from normality. Multivariate analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications. Results 466 men underwent IPP revision. Of these, 377 had complete exchange of the entire device and 89 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (6.7% vs 2.1%, p=0.034). Although the partial exchange group was more likely to receive antifungals (52.8 vs 17.8%, p&amp;lt;0.001) and have a modified salvage washout (78.4 vs 61.2%, p=0.003), this cohort was less likely to receive vancomycin and gentamicin for antimicrobial prophylaxis (60.7 vs 81.7%, p&amp;lt;0.001). Time to revision from original implantation was significantly shorter in the partial exchange group (46 vs 168 months, p&amp;lt;0.001). In multivariate analysis, partial exchange surgery (OR 2.6, 95%CI 0.7-9.5, p=0.15), vancomycin and gentamicin antimicrobial prophylaxis (OR 0.4, 95%CI 0.1-1.5, p=0.20), modified salvage washout (OR 1.6, 95%CI 0.3-8.4, p=0.54), and antifungal prophylaxis (OR 2.7, 95%CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of mechanical complications (20.2% vs 10.6%, p=0.019) such as pump malfunction and tubing breakage. Conclusions While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases the risks in men undergoing IPP revision for non-infectious indications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Antares Pharma, Clarus Therapeutics, Cynosure, Promescent, Sprout, Viome

PD42-02 PARTIAL COMPONENT EXCHANGE OF A NON-INFECTED IPP IS ASSOCIATED WITH A HIGHER COMPLICATION RATE

You have accessJournal of UrologyCME1 Apr 2023PD42-02 PARTIAL COMPONENT EXCHANGE OF A NON-INFECTED IPP IS ASSOCIATED WITH A HIGHER COMPLICATION RATE David Barham, Muhammed Hammad, Edward Choi, Daniel Swerdloff, Brittany Berk, Eric Chung, Jonathan Clavell-Hernandez, Martin Gross, Tung-Chin Hsieh, James Jones, Martin Kathrins, Aaron Lentz, Patrick Selph, Jay Simhan, Robert Welliver, and Faysal Yafi David BarhamDavid Barham More articles by this author , Muhammed HammadMuhammed Hammad More articles by this author , Edward ChoiEdward Choi More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Brittany BerkBrittany Berk More articles by this author , Eric ChungEric Chung More articles by this author , Jonathan Clavell-HernandezJonathan Clavell-Hernandez More articles by this author , Martin GrossMartin Gross More articles by this author , Tung-Chin HsiehTung-Chin Hsieh More articles by this author , James JonesJames Jones More articles by this author , Martin KathrinsMartin Kathrins More articles by this author , Aaron LentzAaron Lentz More articles by this author , Patrick SelphPatrick Selph More articles by this author , Jay SimhanJay Simhan More articles by this author , Robert WelliverRobert Welliver More articles by this author , and Faysal YafiFaysal Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of malfunctioning inflatable penile prostheses (IPPs) is varied. The impact of partial component exchange versus complete device exchange on complications is unknown. We sought to describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction. METHODS: We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components (i.e. pump revision only, or pump and reservoir exchanged but cylinders left in situ). Differences between baseline demographics were assessed with two tailed student t-tests and Fisher’s exact tests. Multivariable analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications. RESULTS: 453 men underwent IPP revision. 368 had complete exchange of the entire device and 85 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (7.1% vs 2.2%, p=0.031). The partial exchange group also was more likely to receive antifungals (51.8 vs 16.8%, p<0.001), have a modified salvage washout (77.4 vs 60.2%, p=0.004), and less likely to receive vancomycin and gentamicin (63.5 vs 83.7%, p<0.001). Time to revision was significantly shorter in the partial exchange group (44.9 vs 168.2 months, p<0.001). In multivariable analysis, partial exchange surgery (OR 2.6, 95% CI 0.7-9.3, p=0.17), vancomycin and gentamicin prophylaxis (OR 0.3, 95% CI 0.1-1.2, p=0.11), modified salvage washout (OR 1.8, 95% CI 0.3-9.2, p=0.48), and antifungal prophylaxis (OR 2.7, 95% CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of non-infectious complications (21.2% vs 9.5%, p=0.005) such as pump malfunction and tubing breakage. CONCLUSIONS: While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases risks in men undergoing IPP revision for non-infectious indications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1111 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author Muhammed Hammad More articles by this author Edward Choi More articles by this author Daniel Swerdloff More articles by this author Brittany Berk More articles by this author Eric Chung More articles by this author Jonathan Clavell-Hernandez More articles by this author Martin Gross More articles by this author Tung-Chin Hsieh More articles by this author James Jones More articles by this author Martin Kathrins More articles by this author Aaron Lentz More articles by this author Patrick Selph More articles by this author Jay Simhan More articles by this author Robert Welliver More articles by this author Faysal Yafi More articles by this author Expand All Advertisement PDF downloadLoading ...

Riluzole, a neuroprotective agent, preserves erectile function following bilateral cavernous nerve injury in male rats.

Neurogenic erectile dysfunction is a highly prevalent complication in men undergoing radical prostatectomy. The underlying mechanisms remain incompletely defined and the effective therapy has been limited. This study aimed to evaluate the protective effect of riluzole and the role of PKC β and excitatory amino acid transporters (EAATs) mediating this effect in a rat model of bilateral cavernous injury (BCNI). A total of 48 male Sprague-Dawley rats were divided into sham, BCNI (at 7, 15 days post-injury) and BCNI treated with riluzole (8 mg/kg/day) groups. Erectile function was measured as maximum intracavernosal pressure (mICP)/mean arterial pressure (MAP) and total ICP/MAP. Changes in protein expressions of phospho (p)-PKC β IIser660 and EAATs were analysed in penis and major pelvic ganglion with western blotting. BCNI decreased erectile function at 7 and 15 days post-injury (mICP/MAP at 4 V: 0.45 ± 0.06 vs 0.84 ± 0.07; 0.34 ± 0.04 vs 0.77 ± 0.04 respectively; p < 0.001) whereas riluzole treatment (for 15 days) preserved erectile function (mICP/MAP at 4 V: 0.62 ± 0.03 vs 0.34 ± 0.04; p < 0.01). The decline in the expression of p-PKC β IIser660 was observed in penis at 7 and 15 days post-injury (p = 0.0003, p = 0.0033), which was prevented by riluzole treatment for 15 days (p = 0.0464). While expressions of EAAT-1 and EAAT-2 decreased in major pelvic ganglion following BCNI (p = 0.0428, p = 0.002), riluzole treatment for 15 days prevented the decrease only in EAAT-2 expression (p = 0.0456). Riluzole improved erectile function via possibly interacting with PKC β II and glutamatergic pathways, as a potential therapeutic candidate for erectile dysfunction.

Rectal culture-based versus empirical antibiotic prophylaxis to prevent infectious complications in men undergoing transrectal prostate biopsy: A randomized, non-blinded multicenter trial

Rectal culture-based versus empirical antibiotic prophylaxis to prevent infectious complications in men undergoing transrectal prostate biopsy: A randomized, non-blinded multicenter trial

Partial Component Exchange of a Non-Infected Inflatable Penile Prosthesis is Associated With a Higher Complication Rate

ObjectiveTo describe the infectious and non-infectious complications in men undergoing Inflatable penile prosthesis (IPP) revision with partial and complete component exchange for mechanical malfunction. MethodsWe performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into those who had complete exchange of the entire device or partial exchange of only one or 2 components. Infectious and non-infectious complications were compared between groups. ResultsThree hundred sixty-eight men had complete exchange of the entire device and 85 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (7.1% vs 2.2%, P = .031). The partial exchange group also was more likely to receive antifungals (51.8 vs 16.6%, P < .001), have a modified salvage washout (77.4 vs 60.2%, P = .004), and less likely to receive vancomycin and gentamicin (63.5 vs 83.7%, P < .001). Time to revision was significantly shorter in the partial exchange group (44.9 vs 168.2 months, P < .001). Mean follow-up was slightly longer in the complete exchange group (18.3 vs 13.0 months). In multivariable analysis, partial exchange surgery, vancomycin and gentamicin prophylaxis, modified salvage washout, and antifungal prophylaxis were no longer associated with postoperative infections. The partial exchange group had greater rates of non-infectious complications (21.2% vs 9.5%, P = .005) such as pump malfunction and tubing breakage. ConclusionPatients undergoing partial component revision had more infectious and non-infectious complications. These findings suggest that partial component exchange increases complications in men undergoing IPP revision.

Association Between Uric Acid to HDL Cholesterol Ratio and Diabetic Complications in Men and Postmenopausal Women

Previous studies have implicated the uric acid to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) was associated with type 2 diabetes. However, the association between UHR and diabetes-related vascular damages is still unclear. The total of 4551 patients with type 2 diabetes from the cross-sectional Environmental Pollutant Exposure and Metabolic Diseases in Shanghai study (METAL study) were enrolled. UHR was calculated as uric acid to HDL-C ratio. Cardiovascular disease (CVD) was defined as previously diagnosed with stroke, coronary heart disease, or peripheral arterial disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 and/or urinary albumin to creatinine ratio ≥30 mg/g. Fundus image was examined by trained individuals and degree of diabetic retinopathy (DR) was evaluated. UHR was positively correlated with CVD (OR = 1.28, 95% CI: 1.02-1.61) and CKD (OR = 1.78, 95% CI: 1.39-2.27) after adjusting for all confounders. No association was found between UHR and DR. In stratified analyses, UHR was predominantly correlated with CVD in diabetic patients with age older than 65 (OR = 1.41, 95% CI: 1.08-1.85), female (OR = 1.43, 95% CI: 1.06-1.94) and BMI≥24kg/m2 (OR = 1.57, 95% CI: 1.17-2.11). A 1-SD increment of UHR was also positively associated with CVD (OR 1.26, 95% CI 1.03, 1.15) and CKD (OR 1.28, 95% CI 1.20,1.39). UHR was positively associated with CKD in all subgroups analysis. No significant interaction effect was observed between UHR and all subgroup variables in CVD and CKD risk. Our study reported a positive association between the UHR and diabetic-related vascular complications in men and postmenopausal women. The relationship between the UHR and DR seems to be uncertain and requires further investigation. And no significant interaction effect was observed between the UHR and all subgroup variables in CVD and CKD risk.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy.

Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B). We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.

Why We Need Sex-Gender Medicine: The Striking Example of Type 2 Diabetes

Type 2 diabetes mellitus is a widespread and a chronic disease associated with micro- and macrovascular complications and is a well-established risk factor for cardiovascular disease, which are among the most important causes of death in diabetic patients. This disease is strongly affected by sex and gender: sex-gender differences have been reported to affect diabetes epidemiology and risk factors, as well as cardiovascular complications associated with diabetes. This suggests the need for different therapeutic approaches for the management of diabetes-associated complications in men and women. In this review, we describe the known sex-gender differences in diabetic men and women and discuss the therapeutic approaches for their management. The data reported in this review show that a sex-gender approach in medicine is mandatory to maximize the scientific rigor and value of the research. Sex-gender studies need interdisciplinarity and intersectionality aimed at offering the most appropriate care to each person.

416-P: Mortality, Major Adverse Cardiovascular Events (MACE) and Diabetic Complications in Men with Hypogonadism and Type 2 Diabetes on Long-Term Testosterone Treatment: An Update from a Urological Registry Study

Background: Men with hypogonadism are at increased risk of MACE and mortality. Studies in men with T2DM show that testosterone therapy reduces both MACE and mortality. Methods: In a registry of 883 men with hypogonadism, 370 men (41.9%) have T2DM. 190 received TU 1000 mg/12 weeks (T-group) , 180 opted against treatment (CTRL) . All patients received standard diabetes treatment including lifestyle courses at a diabetes center. MACE, mortality, and diabetic complications were recorded and compared between groups. Results: Mean baseline age in the T-group and CTRL was 61.0±5.3 and 63.0±4.9 years. Mean follow-up in T-group and CTRL was 9.0 and 9.7 years. 71 patients (37.4%) in the T-group and 74 (41.1%) in CTRL had a history of cardiovascular disease (myocardial infarction MI, stroke, or coronary artery disease diagnosis) (p&amp;lt;0.05) . Baseline smoking prevalence was 41.6% (79 men) in the T-group and 37.4% (67 men) in CTRL (p=0.415) . The T-group had a worse baseline risk factor profile than CTRL: BMI (36.5±4.4 vs. 32.8±4.7 kg/m²) , systolic blood pressure (163.0±13.3 vs. 145.5±14.5 mmHg) , LDL (4.7±0.8 vs. 4.1±1.4 mmol/L) , HbA1c 9.5±1.4 vs. 7.8±0.7% (p&amp;lt;0.00for all) . Mortality: during the entire observation period, 21 patients (11.1%) died in the T-group vs. 62 (34.4%) in CTRL (p&amp;lt;0.0001) . Major adverse cardiovascular events (MACE) : in the T-group, there were no cases of MI or stroke. In CTRL, there were 62 cases of MI (34.4%) and 51 cases of stroke (28.3%) . Diabetic complications: in the T-group and CTRL, the incidence of retinopathy was 4 (2.1%) vs. 30 (16.7%) (p&amp;lt;0.0001) , nephropathy 1 (0.01%) vs. 7 (0.4%) (p=0.05) , polyneuropathy (5.3%) vs. 97 (53.9%) (p&amp;lt;0.0001) , diabetic foot syndrome 0 (0%) vs. 17 (9.4%) (p&amp;lt;0.0001) . Conclusions: Long-term treatment with TU in men with hypogonadism and T2DM reduces mortality, MACE, and diabetic complications, compared to untreated controls. Disclosure K.S.Haider: Other Relationship; Bayer AG. A.Haider: Other Relationship; Bayer AG. F.Saad: Consultant; Bayer AG, Stock/Shareholder; AbbVie Inc., Bayer AG, GlaxoSmithKline plc. Funding Bayer AG

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

Indications of oxygenation after thoracic operations depending on the method of selection of dual endobronchial tube used

Annotation. Pulmonary complications are a key problem in the postoperative period in patients with diseases of the thoracic cavity. They are characterized as the main factors of longer recovery and hospital mortality. The aim of the study was to compare the indicators of oxygenation of patients and the number of postoperative pulmonary complications after thoracic surgery, depending on the method used to select a dual endobronchial tube. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), operated on in the thoracoabdominal department of the Shalimov National Institute of Surgery and Tranplantology. A retrospective comparison group – 96 patients after thoracic surgery, which used the choice of DLT size according to the well-known method of Slinger “according to the patient's height”. The study group consisted of 96 patients after thoracic surgery, in which the choice of the size of the dual endobronchial tube was used according to the developed method (according to the formula that evaluates morphometric indicators of height, sex and diameter of the left main bronchus). EZR v 1.54 statistical software was used for statistical calculations. (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). Pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p=0.001. One-factor analysis revealed a link between the risk of complications and the indicators method, sex, PaCO2, PaO2. For the study group, the risk of complications is lower (p=0.001), BP=0.30 (95% CI 0.15-0.61) compared with the control group. The risk of complications for men is higher (p=0.048), BP=2.33 (95% CI 1.01–5.37) compared to women. An increase in the risk of complications with an increase in PaCO2 (p&lt;0.001), BP=1.34 (95% CI 1.21-1.49) with an increase in the indicator by 1 unit, respectively. With increasing PaO2, the risk of complications decreases (p&lt;0.001): BP=0.96 (95% CI 0.94-0.98) – with increasing 1 unit. Thus, the application of the proposed method in comparison with the traditional method reduces (p=0.001) the number of postoperative pulmonary complications by 2.5 times (from 34.4% to 13.5%).