Placement Of Prosthesis Research Articles

Early Inflatable penile prosthesis implantation offers superior outcomes compared to delayed insertion following ischemic priapism: a narrative review.

Ischemic priapism is a urological emergency which may lead to irreversible erectile dysfunction. One of the accepted treatments is penile prosthesis implantation. Given the scarcity of studies directly comparing timing of penile prosthesis insertion after ischemic priapism, consensus remains elusive. We aim to compare different studies in the literature concerning advantages and disadvantages of early versus delayed inflatable penile prosthesis following ischemic priapism. We analyzed 8 articles that investigated immediate and delayed inflatable penile prosthesis placement after ischemic priapism. Early inflatable penile prosthesis placement is associated with better outcomes, including pain relief, priapism resolution, penile shortening prevention, and quicker sexual activity resumption. However, it still carries a high risk of complications like edema, infection, and distal perforations. Delayed inflatable penile prosthesis insertion poses surgical challenges due to the potential for extensive corporal fibrosis. Comparative analyses have shown elevated complication rates in patients with ischemic priapism who undergo delayed inflatable penile prosthesis insertion, as opposed to those with early insertion. In studies reporting complications rates, the total complication rate in the early group was 3.37%, significantly lower than the delayed group (37.23%). Most studies support the superiority of early inflatable penile prosthesis placement following ischemic priapism over delayed placement. Further research is, however, needed to establish a global consensus on timing of prosthesis insertion.

Prepectoral versus Subpectoral Breast Reconstruction after Nipple-sparing Mastectomy: A Systematic Review and Meta-Analysis.

Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total submuscular (TSM), dual-plane (DP), and prepectoral (PP) planes; however, a dedicated meta-analysis relevant to NSM is lacking. We conducted a systematic review of studies on immediate breast reconstruction after NSM using TSM, DP, or PP prosthesis placement in PubMed, Embase, and Cochrane databases. In total, 1317 unique articles were identified, of which 49 were included in the systematic review and six met inclusion criteria for meta-analysis. Pooled descriptive outcomes were analyzed for each cohort for all 49 studies. Fixed-effects meta-analytic methods were used to compare PP with subpectoral (TSM and DP) reconstructions. A total of 1432 TSM, 1546 DP, and 1668 PP reconstructions were identified for descriptive analysis. Demographics were similar between cohorts. Pooled descriptive outcomes demonstrated overall similar rates of reconstructive failure (3.3%-5.1%) as well as capsular contracture (0%-3.9%) among cohorts. Fixed-effects meta-analysis of six comparative studies demonstrated a significantly lower rate of mastectomy flap necrosis in the PP cohort compared with the subpectoral cohort (relative risk 0.24, 95% confidence interval [0.08-0.74]). All other consistently reported outcomes, including, hematoma, seroma, infection, mastectomy flap necrosis, nipple -areola complex necrosis, and explantation were comparable. A systematic review of the literature and meta-analysis demonstrated the safety of immediate prepectoral breast reconstruction after NSM, compared with submuscular techniques. Submuscular reconstruction had a higher risk of mastectomy flap necrosis, though potentially influenced by selection bias.

RESULTS OF ROBOTIC ASSISTED VS CONVENTIONAL TOTAL KNEE ARTHROPLASTY AT 1 YR FOLLOW UP

Background: Osteoarthritis (OA) of the knee is a prevalent condition among older individuals, causing significant discomfort and impairments in quality of life. Conventional total knee arthroplasty (COTKA) is a common treatment, but issues such as inadequate soft tissue balance and prosthesis misalignment can impact outcomes. Robotic-assisted total knee arthroplasty (RATKA) has emerged as a potential solution, offering enhanced precision in prosthesis placement. While observational studies suggest benefits, comprehensive reviews of randomized controlled trials (RCTs) are lacking. This study aims to fill this gap by evaluating the clinical, functional, and radiological outcomes of RATKA compared to COTKA in adult patients with primary knee OA. Methods: This prospective study was conducted at a specialized orthopedic center, involving patients diagnosed with symptomatic knee OA eligible for total knee replacement (TKR). Patients were allocated to either conventional TKR (Group A) or robotic-assisted TKR (Group B). Outcome measures included Visual Analog Scale (VAS) for pain, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient satisfaction, and quality of life assessments. Radiological outcomes were assessed using standardized radiographs. Statistical analyses included descriptive statistics, group comparisons, and repeated measures analysis of variance (ANOVA). Results: Baseline characteristics showed similar distributions between Group A (n=30) and Group B (n=30). Clinical outcomes demonstrated significant improvements over time in both groups, with Group B consistently outperforming Group A across all measures. Notably, Group B exhibited lower pain scores (VAS), higher functional scores (KSS), lower disability scores (WOMAC), higher patient satisfaction, and better quality of life assessments. Radiological outcomes also favored Group B, with improved mechanical axis deviation and component positioning. Conclusion: Robotic-assisted TKR demonstrated superior clinical, functional, and radiological outcomes compared to conventional TKR in patients with knee OA. These findings support the growing body of evidence favoring the use of robotic technology in TKR procedures, particularly for optimizing implant placement and alignment. Future research should focus on cost-effectiveness and long-term outcomes to further inform clinical practice and enhance patient care.

Salvage procedures for infected penile implants: A comprehensive review and analysis of functional outcomes

BackgroundThe salvage procedure for infected penile implants (IPs) has been a subject of interest since its inception in the late 1980s, yet its widespread adoption remains limited. The aim of this study was to realize a systematic literature review to provide a comprehensive analysis of salvage techniques for IPs and assess their efficacy, specifically focusing on functional success. MethodsA systematic literature review was conducted using PubMed, employing Mesh terms related to penile prosthesis, penile implant, infection, and salvage procedures. Articles in French or English were considered for the final analysis, with exclusion of literature reviews. ResultsFifteen articles detailing various salvage techniques for IPs were identified. Mulcahy's initial technique was described in 1996, and consisted of complete removal of infected components, extensive lavage, and subsequent replacement with a similar implant. Success rates ranged from 80% to 100%, with emerging trends favoring the use of malleable implants during salvage. Unfortunately, functional data remained limited. When salvage penile prosthesis placement involved a malleable prosthesis, between 20% and 33% of patients underwent conversion to hydraulic prosthesis. ConclusionThe salvage procedure for infected penile implants is a reliable method, with success rates surpassing 80%. The need for comparative studies assessing the type of implant used during salvage is required to tailor conservative management strategies for optimal patient outcomes. Finally, few data have been published regarding subsequent conversions from malleable penile implants to hydraulic penile implants after salvage.

Bilateral Congenital Anorchidism: Case Study

Embryonic testicular regression syndrome (ETRS) or congenital bilateral anorchidism (CBA) is a highly rare syndrome defined by the complete absence of testicular tissue in a patient with a male karyotype. The phenotype varies depending on when gonadal regression occurs in utero. Clinically, a micropenis, hypoplastic scrotum, empty, without perceived testicles are observed. Hormonal assessments reveal collapsed or completely absent testosterone levels and AMH (anti-Mullerian hormone) levels. Diagnosis is confirmed by laparoscopic exploration. Management relies on androgen supplementation and placement of testicular prostheses.

Is AI 3D-printed PSI an accurate option for patients with developmental dysplasia of the hip undergoing THA?

BackgroundIn traditional surgical procedures, significant discrepancies are often observed between the pre-planned templated implant sizes and the actual sizes used, particularly in patients with congenital hip dysplasia. These discrepancies arise not only in preoperative planning but also in the precision of implant placement, especially concerning the acetabular component. Our study aims to enhance the accuracy of implant placement during Total Hip Arthroplasty (THA) by integrating AI-enhanced preoperative planning with Patient-Specific Instrumentation (PSI). We also seek to assess the accuracy and clinical outcomes of the AI-PSI (AIPSI) group in comparison to a manual control group.MethodsThis study included 60 patients diagnosed with congenital hip dysplasia, randomly assigned to either the AIPSI or manual group, with 30 patients in each. No significant demographic differences between were noted the two groups. A direct anterior surgical approach was employed. Postoperative assessments included X-rays and CT scans to measure parameters such as the acetabular cup anteversion angle, acetabular cup inclination angle, femoral stem anteversion angle, femoral offset, and leg length discrepancy. Functional scores were recorded at 3 days, 1 week, 4 weeks, and 12 weeks post-surgery. Data analysis was conducted using SPSS version 22.0, with the significance level was set at α = 0.05.Results and conclusionThe AIPSI group demonstrated greater prosthesis placement accuracy. With the aid of PSI, AI-planned THA surgery provides surgeons with enhanced precision in prosthesis positioning. This approach potentially offers greater insights and guidelines for managing more complex anatomical variations or cases.

Late iris cerclage suture cheese-wiring.

To describe a case series of cerclage failures due to cheese-wiring; iris repair can develop late cheese-wiring of cerclage sutures with resultant loss of benefits. Cincinnati Eye Institute, Cincinnati, Ohio. Retrospective single-surgeon case series. A retrospective chart review sought patients who underwent iris cerclage at the Cincinnati Eye Institute who later developed suture cheese-wiring. The patient symptoms, demographics, cerclage size, suture type, knot type, iris status, and suture status at final follow-up were ascertained. 6 cases of cerclage suture cheese-wiring with loss of the original surgical benefit were identified. 10-0 polypropylene suture and a 3-1-1 knot were used in each case. The suture remained intact with an intact knot and suture loop in all cases. Cheese-wiring with return of mydriasis is a potential long-term outcome of iris cerclage suture placement, with return of preoperative symptoms. Awareness of this potential eventuality provides physicians and patients a broader perspective when selecting between cerclage suture, iris prosthesis placement, or other surgical and nonsurgical options.

Comparison of short-term radiographic outcomes of medial parapatellar, mini-midvastus, and subvastus surgical approaches in fast-track total knee arthroplasty

Purpose: Due to the difficulties in accessing the knee joint, correct prosthesis placement is of great importance during the implementation of total knee arthroplasty (TKA). This study aimed to compare short-term radiographic X-ray outcomes in patients who underwent fast-track TKA with medial parapatellar (MPP), mini-midvastus (mMV), or subvastus (SV) surgical approaches.
 Materials and methods: Between 2018 and 2020, 93 patients operated with MPP, mMV, and SV surgical approaches and who had complete data of radiographic outcomes before and sixth-week postoperative were retrospectively analyzed and patients divided into three groups: MPP (n=31), mMV (n=31), and SV (n=31). The alignments of preoperative and sixth-week postoperative X-ray images of the surgical approaches were measured. The operative time of fast-track TKA implementation with MPP, mMV, and SV surgical approaches was recorded.
 Results: The MPP group had higher preoperative lateral distal femoral angle than the mMV group and a higher preoperative lateral proximal femoral angle than SV group (p=0.018 and p=0.027, respectively). The mMV group had higher postoperative proximal medial tibial angle than SV group (p=0.011). In the postoperative sixth week, the MPP and mMV groups had a lower posterior tibial slope angle than SV group (p=0.001). The MPP approach had significantly shorter operative time than mMV and SV approaches (p=0.001).
 Conclusion: The outcomes indicate that MPP, mMV, and SV surgical approaches are preferable and feasible in obtaining a satisfactory prosthesis alignment during fast-track TKA. The MPP approach may be preferable because of its shorter operative time and potential advantage in minimizing surgical complication risks.

Does retained cement or hardware during 2-stage revision shoulder arthroplasty for infection increase the risk of recurrent infection?

IntroductionWhen treating chronic prosthetic joint infection (PJI) after shoulder arthroplasty, removal of the implants and cement is typically pursued because they represent a potential nidus for infection. However, complete removal can increase morbidity and compromise bone stock that is important for achieving stable revision implants. The purpose of this study is to compare the rates of repeat infection after 2-stage revision for PJI in patients who have retained cement or hardware compared to those who had complete removal. Material and MethodsWe retrospectively analyzed all two-stage revision total shoulder arthroplasties (TSAs) performed for infection at two institutions between 2011 and 2020 with minimum two-year follow-up from completion of the two-stage revision. Patients were included if they met the International Consensus Meeting (ICM) criteria for probable or definite infection2. Postoperative radiographs after the first-stage of the revision consisting of prosthesis and cement removal and placement of an antibiotic spacer were reviewed to evaluate for retained cement or hardware. Repeat infection was defined as either ≥2 positive cultures at the time of second-stage revision with the same organism cultured during the first-stage revision or repeat surgery for infection after the two-stage revision in patients that again met the ICM criteria for probable or definite infection. The rate of repeat infection among patients with retained cement or hardware was compared to the rate of infection among patients without retained cement or hardware. ResultsThirty-seven patients met inclusion criteria and were included in the analysis. Six (16%) patients had retained cement and one patient (3%) had two retained broken glenoid baseplate screws after first-stage revision. Of the ten cases of recurrent infection, one case (10%) involved retained cement/hardware. Age at revision (60.9±10.6 vs. 65.0±9.6, p=0.264), BMI (33.4±7.2 vs. 29.7±7.3, p=0.184), Charlson Comorbidity Index (2 (0-8) vs. 3 (0-6), p=0.289), male sex (7 vs. 16, p=0.420) and presence of diabetes (1 vs. 3, p=0.709) were not associated with repeat infection. Retained cement or hardware was also not associated with a repeat risk of infection (1 vs. 6, OR=0.389, p=0.374). DiscussionWe did not find an increased risk of repeat infection in patients with retained cement or hardware compared to those without. Therefore, we believe that surgeons should consider leaving cement or hardware that is difficult to remove and may lead to increased morbidity and future complications.

Penoscrotal inflatable penile prosthesis recipients often fully recover from pain at two weeks following placement.

The symptoms and duration of pain following inflatable penile prosthesis (IPP) surgery remains poorly understood. We characterize postoperative pain following penoscrotal 3-piece inflatable penile prosthesis placement in patients managed with a standardized pain management protocol. This is a single-center prospective analysis of 96 virginal penoscrotal 3-piece IPP recipients (9/2019 to 9/2021) excluding patients with chronic pain, IPPs performed with alternative approaches or concomitantly with other surgeries and those with infections. Standardized pain questionnaire was performed by phone on post-operative day (POD) 2, 7, 14, and 30. The primary outcome was self-reported pain scores, measured by pain score 0-10 (0 = no pain, 10 = unbearable, "worst pain you have ever felt") at various locations (incision, penile, scrotal, abdominal) over the first 30 days postoperatively. A majority of pain reported was outside the scrotal area with 67.6% of complaints in the shaft, glans, abdomen and incision. From POD2 to POD30, there was a significant decrease in severe pain from 46.2 to 11.1% (p = 0.05) with an increase in mild pain from 23.1 to 62.4% (p = 0.05). Roughly half of the participants (47.9%, n = 46) reported no pain by POD14. Penoscrotal IPP recipients often fully recover from pain at the two-week period following surgery and those with lingering discomfort predominantly complain of penile shaft and glans pain.

Two-Stage Total Hip Arthroplasty Management in Advanced Legg-Calvé-Perthes Disease: A Case Report

Introduction: Legg-Calvé-Perthes-Disease (LCPD) most commonly affects boys between the ages of 4 and 8. It is an avascular necrosis of the upper femoral epiphysis. Its etiopathogenesis is unknown. Advanced cases necessitate innovative approaches beyond conservative measures. We report a challenging case involving radical treatment for advanced LCPD already complicated by hip and knee stiffness, managed with a two-stage total hip arthroplasty. Case presentation: We report the case of a 14-year-old with chronic left hip impairment and concurrent knee stiffness due to advanced LCPD. Initial conservative interventions proved ineffective. We decided to opt for a two-stage surgical strategy. The first stage involved femoral head ostectomy, cervico-cephalic prosthesis placement, and soft tissue tenotomy. Subsequent intensive rehabilitation achieved improved joint mobility. The second stage comprised total hip replacement using a ceramic-ceramic prosthesis. At last follow up, a favorable functional outcome was observed, and radiographs demonstrated a well-positioned and osteo-integrated prosthesis. Conclusions: LCPD is a serious condition, and the prognosis is significantly influenced by early diagnosis and appropriate management. In cases of advanced staged LCPD, prosthetic replacement becomes a suitable option, even in younger patients. Despite potential complications, the use of a two-stage approach, integrating surgical intervention and tailored rehabilitation, proved effective in restoring joint function. This case highlights the importance of personalized planning and a staged approach in addressing the multifaceted aspects of LCPD.

Clinical Practice Patterns for Surgical Shunts and Penile Prosthesis Placement in Men With Priapism: A Retrospective Large Claims Database Analysis.

The objective of this study was to assess the rates of surgical shunting and prosthesis placement for acute ischemic priapism using a large multi-institutional claims database. A US claims database network (TriNetX Diamond Network) was queried from 2010 to 2020. We constructed a cohort of men ages ≥ 16 years who (1) had a diagnosis of priapism and (2) underwent an irrigation of the corpora cavernosa for priapism. We assessed the number of men who then had a surgical penile shunt or penile prosthesis placement. Demographics, time to surgical procedure, and order of procedures were collected. A total of 6392 men were identified with the diagnosis of priapism and the procedure of corpora cavernosal irrigation. Of these men, 693 (11%) proceeded to surgical shunt. One hundred forty-four men (2%) underwent initial penile prosthesis placement. Of the men undergoing initial penile prosthesis, only 17 of 144 (12%) cases occurred within the first month of corpora cavernosal irrigation. Finally, when assessing choice of initial shunts vs initial penile prosthesis before and after 2015, overall rates of initial shunt (10.0% vs 8.5%, P < .0001) and initial prosthesis (3.1% vs 2.1%, P < .0001) were lower after 2015 when compared with rates prior to 2015. In this US claims-based analysis of men presenting with ischemic priapism and treated with initial irrigation, a small percentage (11%) of men went on to receive surgical shunting, and only 2% received an initial prosthesis. Men receiving initial prostheses were more likely to have more comorbidities, and overall surgical management of priapism has decreased over time.

Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study.

To compare between the rehabilitation of atrophied maxilla with fixed prosthesis using two posterior zygomatic implants and two conventional anterior implants or four implants inserted according to the all-on-four concept regarding the patient quality of life and satisfaction after one year of prosthesis insertion. Thirty-six patients with atrophic edentulous maxillae were randomized into two groups: Group I (rehabilitated with fixed prostheses supported by two zygomatic and two conventional implants in the anterior region) and group II (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after the placement of the definitive prostheses, patients completed oral health impact profile-14 and satisfaction questionnaires. All patients were satisfied regarding retention, stability, occlusion, comfort, cleaning, speaking, chewing, bolus quality, appearance, handling, prosthesis apart, and embarrassing, with no significant significance between two groups except satisfaction with surgical procedures and healing period. Using two distally tilted zygomatic implants or all-on-four concept to rehabilitate atrophied maxilla by fixed detachable prosthesis could be considered a promising functional and esthetic treatment option regarding the patient satisfaction. Traditionally, treatment of maxillary atrophied ridges was done by bone grafting or sinus-lifting techniques; however, using all-on-four concept or zygomatic implants was a successful treatment as it has high success rates and highly satisfied by the patients. How to cite this article: Nagib MA, Ibrahim AM, Abdel-Rahman FH, et al. Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(2):141-147.

Evidence-Based Recommendations in Primary Tracheoesophageal Puncture for Voice Prosthesis Rehabilitation.

Head and neck cancer, the seventh most common cancer worldwide, often affects the larynx, with a higher incidence in men. Total laryngectomy, a common treatment, results in the loss of phonation, and tracheoesophageal voice rehabilitation is the current rehabilitation method of choice. Despite ongoing debates regarding the timing of tracheoesophageal puncture (TEP), a crucial procedure for voice prosthesis placement, the secondary puncture continues to be the preferred choice in the majority of cases. This underscores the persistent controversy and the absence of consensus in this field. The aim of this manuscript was to define evidence-based recommendations regarding the procedure of primary TEP with voice prosthesis placement, establish the conditions and requirements for performing primary TEP, determine the indications and contraindications of primary TEP, as well as to define the complications and management of primary TEP. A total of 19 statements were formulated, with 78.95% of them having a Level of Evidence 4 and a Grade of Recommendation C. There is not sufficient evidence comparing the outcomes of primary TEP versus secondary TEP. Future studies with robust methodologies are needed to clarify the role of primary and secondary TEP in the rehabilitation of patients undergoing total laryngectomy.

Glans hypermobility scale (GHS): A simple grading scale and description of a modified glanspexy technique.

Glans hypermobility (GH) is a well-described clinical entity that can have significant implications for cosmesis and function, resulting in sexual dissatisfaction, penile pain, and early device erosion, with an estimated incidence of 0.04% to 10%. We developed a novel grading scale to assess GH severity intraoperatively during primary inflatable penile prosthesis (IPP) placement and describe a modified glanspexy technique to correct GH when encountered during IPP placement. 530 patients who underwent primary IPP placements from two high-volume prosthetic surgeons between February 2018 - November 2019 were retrospectively reviewed in order to identify the incidence of GH. Of these, 139 (26.2%) had hypermobility. Employing our new scaling system, grade 1, 2, and 3 GH was seen in 86 (16.2%), 29 (5.5%), and 24 (4.5%) cases, respectively. Increased implant size correlated with a decreased likelihood of GH incidence. Each increase in implant size by 1 cm decreased the incidence of detecting GH by 11.0% (OR = 0.89; p = 0.015). 11 patients underwent primary GH repair using our described technique. At one-year follow-up, one patient required repeat glanspexy for recurrent bothersome GH and a second patient developed a suture granuloma at the glanspexy incision requiring unilateral cylinder explant. Our modified glanspexy technique can be used to correct GH in any direction and is a useful tool for the prosthetic surgeon's armamentarium.

(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.

(037) Trans Obturator Repositioning Sling (TOROS); Novel Proximal Fixation of Penile Prosthesis Cylinder in Neophallus

Abstract Introduction The placement of Penile Prosthesis (PP) in transgender men with a neophallus is technically demanding and poses challenges specifically related to the extracorporal proximal anchoring of the cylinders owing to the lack of proximal corpora. We herein designed a novel Trans-Obtutrator Repositioning Sling (TOROS) for the proximal PP cylinder anchoring in a phallus of cisgender man or a neophallus of transgender man. Objective To assess the safety and efficacy of this novel surgical approach for the extracorporal proximal PP cylinder anchoring (TOROS) in two patients (cisgender and transgender) through refashioned use of the AdVanceTM Male Sling System (Boston Scientific). We herein present one video (first patient) to demonstrate step by step surgical technique. Methods Two patients were included. First patient is a 38-year-old cisgender male with a history of micropenis who underwent anterolateral thigh phalloplasty in 2017 presents for PP insertion. Second patient is 35 year old transgender with history of right free flap forearm phalloplasty 2019 with prior failed PP revision presents with perineal pain at level of proximal PP cylinder. Both patients consented and elected to proceed. Results After careful identification of neophallus vascular pedicle with handheld doppler, a perineal midline incision was made. The space within the neophallus was carefully dissected, dilated up to 11mm with Hegar dilator and measured for upcoming PP cylinder. Next and similar AdVance Male Sling surgical approach, the Adductor Longus tendon identified as a landmark, a trocar was inserted carefully through the obturator foramen around the inferior ischiopubic ramus. The sling was pulled via perineal incision and refashioned into socket-like sling to house the proximal end of PP cylinder or Rear Tip Extender (RTE) (in this case). To further reinforce this connection, sling flanges wrapped around and suture fixated. Next a single-cylinder Ambicor PP (Boston Sci) is inserted. PP pump placed into the left perineal side. Total PP length was 15cm+2cm RTE. PP appeared cycling well. Skin closed in layers. Patient had an uneventful post-op course and discharged on POD #3. At the 6-week mark, the patient had no post-op complaints or complications. The patient has been able to cycle the penile implant twice daily without issue and satisfied with the outcome of the procedure. Conclusions Extra-corporal anchoring of PP cylinders using TOROS is a novel, feasible and potentially changing approach in cisgender or transgender men. Proximal anchoring of the cylinders on the inferior pubic ramus and ramus of the ischium through the modified and refashioned use of trans-obturator male sling mimic natural anatomical attachment of the proximal corpora, and the same approach can applied in a transgender man neophallus with apparent good stability with and without axial loading. Disclosure No.

(060) Epigenetic and Gene Expression Profiles in Non-Plaque Tissues from Men with Peyronie’s Disease

Abstract Introduction Peyronie’s Disease (PD) can significantly impact sexual function. A hereditary predisposition to PD suggests that genetic variants may exist, and gene expression may modulate the penetrance of the disease. Identification of changes in epigenetic and gene expression profiles will facilitate a deeper understanding of the disease and provide insight for more targeted therapies. Objective Our objective is to determine if PD is correlated with epigenetic variations and/or gene expression changes, as indicated by DNA methylation assessment and RNA sequencing. Methods Penile tunica albuginea samples (not from fibrotic plaques) were obtained from men with PD undergoing penile prosthesis placement. Control samples were collected from men with erectile dysfunction (ED) without PD undergoing penile prosthesis placement. DNA methylation analyses were performed on homogenized penile tissue samples via an Illumina Human MethylationEPIC BeadChip v2 array. Using the minfi package in R, beta values were produced for all 936,990 CpG sites for each sample and SWAN normalization was applied. Differentially methylated regions (DMR) were found via USEQ with a threshold Wilcoxon FDR score of 40. Gene expression levels were examined in PD and ED samples via RNA-sequencing. Gene expression data was compared against epigenetic data to determine if any epigenetics changes identified affected gene expression profiles. Results A total of 24 tissue samples were collected: 12 ED and 12 PD. USEQ yielded 36 total DMRs with an FDR score of 40 or greater (p-value&amp;lt;0.0001). Of these 36 DMRs, a Stanford GREAT analysis revealed 60 total gene-region associations and five implicated biological processes: anterior/posterior pattern specification, chordate embryonic development, embryo development (ending in birth or egg hatching), somitogenesis, and pattern specification process. Furthermore, differential gene expression analysis identified 76 genes with significant expression changes between PD and ED groups, of which 17 genes were upregulated while 59 were downregulated. Long noncoding RNAs and the keratocan gene showed notable expression differences between PD and ED groups. GO enrichment analysis revealed significant terms related to DNA binding and protein binding. None of the differentially regulated genes overlapped with identified DMRs. Conclusions This study identified distinct gene expression and DNA methylation patterns between PD and ED groups, despite PD samples not being taken from plaque regions, suggesting that more systemic changes may be present. Upregulated genes in PD included long noncoding RNAs and the keratocan gene, suggesting their involvement in disease pathogenesis. Long noncoding RNA overexpression may serve a regulatory function in gene expression or cell processes while overexpression of the keratocan gene may promote collagen accumulation and remodeling, leading to fibrous plaque formation. Likewise, DMRs and their region-gene associations suggest a role in early embryonic development for pathogenesis. Although RNA-seq did not indicate any significant differentially expressed genes that matched with gene-region associations correlated with DMRs, the significance and quantity of DMRs between ED and PD sample groups is indicative of affected biological processes that manifest in distinct pathophysiologies. Further research is needed to investigate if differentially regulated genes exist in DMRs that exhibited changes but did not meet the criteria threshold for inclusion here. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Contraline, Techfields Inc, Alto Neurosciences, Curebase.

Maxillary Osteomyelitis: A Case Report Highlighting Diagnosis and Treatment Challenges

Osteomyelitis, a condition characterized by inflammatory bone infection involving the medullary cavity, haversian systems, and periosteum, is relatively rare but grave. Historically more prevalent prior to the antibiotic era, it remains a formidable challenge, particularly when comorbid with systemic illnesses such as diabetes mellitus. This case report details the presentation of a 70-year-old male with poorly controlled diabetes mellitus presenting with maxillary osteomyelitis, evidenced by tooth mobility, purulent discharge, and exposed bone areas. Radiographic assessment revealed extensive maxillary bone involvement, corroborated by histopathological examination confirming chronic osteomyelitis. Treatment entailed partial maxillectomy under local anesthesia, necessitated by financial constraints, followed by subsequent monitoring and prosthesis placement. This case underscores the significance of timely diagnosis, interdisciplinary management, and the complexities inherent in treating osteomyelitis complicated by systemic diseases.

(222) Simultaneous Inflatable Penile Prosthesis and Adjustable Male Sling: A Step-by-Step Surgical Technique

Abstract Introduction Erectile dysfunction (ED) and urinary incontinence (UI) are common complications following radical prostatectomy (1). At twenty-four months post-surgery, approximately 43% of men experience some degree of ED, while UI affects around 15% of patients between twelve to twenty-four months (2, 3). Notably, nearly 20% of patients experience both ED and UI complications (4). Initial conservative management strategies include the use of PDE-5 inhibitors, intercavernosal injections, or a vacuum erectile device for ED and pelvic floor muscle training for UI (5). However, symptoms that persist or worsen beyond six months can be considered for surgical intervention (6). Surgical options include penile prosthesis implantation for ED and diverse techniques such as the Artificial Urinary Sphincter (AUS) or adjustable male urethral sling, depending on symptom severity, for UI management. Limited evidence suggests that a simultaneous surgical approach addressing both conditions can be a cost-effective and a safe alternative to separate surgeries (7, 8). Objective In this context, the objective of this video presentation is to illustrate a detailed, step-by-step technique for the simultaneous implantation of an inflatable penile prosthesis (IPP) and an adjustable male sling (AMS), while also discussing its feasibility, safety, and functional outcomes. Methods The combined IPP and AMS surgery is a safe, viable, and cost-effective option for patients who need to address both ED and UI. Rhee (2005) initially described the concurrent placement of a penile prosthesis (PP) and male sling (MS) in a series of four post-prostatectomy patients. Results The results demonstrated successful restoration of erections and complete continence in all patients, with no postoperative complications. Our previous systematic review, comparing the outcomes of simultaneous surgical placement of PP and MS versus PP and artificial urethral sphincter (AUS), found no clinically significant differences in outcomes between the two groups (Raheem 2021). Therefore, the simultaneous placement of IPP and AMS should be considered an option for patients, as it shows comparable effectiveness to other concurrent surgical interventions. Dual implantation of PP and male sling have also demonstrated cost savings of approximately $9,000 for patients, further enhancing its advantages in managing both ED and UI (Gorbatiy 2010). Ultimately, a collaborative discussion between patients and their urologist is crucial in determining the most suitable approach for patient individual needs. Conclusions The simultaneous surgical placement of an inflatable penile prosthesis (IPP) and adjustable male sling (AMS) presents a favorable and viable solution for managing erectile dysfunction (ED) and urinary incontinence (UI) in patients who exhibit an inadequate response to conservative management following prostatectomy. Disclosure No.