Sexual Medicine Society Of North America Research Articles

Cosmetic penile enhancement procedures: an SMSNA position statement.

Penile cosmetic enhancement procedures have been performed for many years with varying success. However, they have historically been relegated to niche areas of sexual medicine, with limited data, and have not achieved mainstream adoption. More recently, the topic has been increasingly discussed within academic congresses due to availability of novel techniques, therapies, and procedures. Given their distinctive nature, the Sexual Medicine Society of North America (SMSNA) felt that it was pertinent to develop formal position statements to help guide both patients and sexual medicine providers on the current state of the scientific literature and to give recommendations for future research. The study sought to provide an evidence-based set of recommendations for injection and surgical procedures designed to lengthen, augment, or otherwise cosmetically enhance the penis. A review was performed of all scientific literature listed in PubMed from inception through December 2023 relating to penile cosmetic enhancement procedures. Only invasive (injection/surgery) therapies were included due to their distinct risk-benefit profile compared with more conservative treatments (eg, vacuum erection devices, penile traction devices). Similar therapies were categorized, with pertinent data summarized and used to help create relevant position statements. All statements were expert opinion only and were based on analyses of the potential risks and benefits of the specific therapies. A total of 6 position statements were issued relating to 5 distinct sexual medicine cosmetic enhancement procedures. A consensus opinion was reached by SMSNA leadership on the state of injection/surgical penile cosmetic enhancement procedures as of 2024. Key topic areas addressed included injectable soft tissue fillers, suspensory ligament division, graft-and-flap procedures, silicone sleeve implants, and sliding/slicing techniques. Distinct recommendations were tailored to each therapy and were based solely on the current state of the literature. It is anticipated that future studies will further inform position statements and will lead to ongoing modifications. The current position statements provide both patients and clinicians evidence-based, expert recommendations on best practices relating to penile cosmetic enhancement procedures. Strengths include the use of an expert panel of sexual medicine clinicians, consensus design, and summary of existing literature. Limitations include expert opinion and limited research on the topic. The current SMSNA position statements provide evidence-based, consensus opinions on the appropriate role for penile augmentation and cosmetic procedures in 2024.

Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper.

The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.

(233) Perceptions and Use of Penile Regenerative and Aesthetic Therapy Among SMSNA Members

Abstract Introduction Wave therapy (WT) and platelet rich plasma (PRP) have been evaluated in multiple medical contexts, but there is paucity of long-term data to support their applications in erectile dysfunction (ED) and Peyronie’s disease (PD). Despite the American Urological Association and Sexual Medicine Society of North America (SMSNA) recommending against the use of these therapies for ED and PD outside of a clinical trial, many practices offer WT and PRP as penile regenerative therapies. Objective We aim to understand current perceptions and practice patterns of SMSNA members in offering penile regenerative and aesthetic therapies. Methods An anonymous online survey was deemed IRB exempt and administered to current members of SMSNA electronically from 4/2023 to 6/2023 asking practitioner’s demographics, practice information, their familiarity and offering of various types of penile regenerative therapy (focused shockwave therapy [fSWT], radial wave therapy [RWT], PRP, stem cell therapy [SCT], penile botulinum toxin [Botox] injection) and penile aesthetic procedures including girth and length-enhancement. We included current SMSNA members who are physicians in practice or Advance Practice Providers (APPs) that practice in the US. We excluded those who are trainees and practice outside the US. We conducted descriptive statistics using RedCap. Results Of the 500 active SMSNA members, 46 completed the survey (response rate 9%). Participants were predominantly male (N=42, 91%), physician (N=43, 93%), fellowship-trained (N=39, 85%), and in practice for a median of 5 years. Participants mostly practiced in academic settings (N=33, 72%), and saw 10 or more patients with ED weekly (N=35, 76%). Most respondents reported being comfortable describing the differences between types of wave therapy (N=28, 61%). A minority of respondents offered RWT (N=3, 7%) and most indicated that there was no to low evidence to support its use (N=31, 67%). Ten respondents offered fSWT (N=10, 22%) and only a minority reported no to low evidence to support the use of fSWT (N=18, 39%). Five respondents (11%) offered PRP and most reported that there was no or low evidence to support use of PRP (N=31, 67%). None of the respondents offered SCT and most reported that there was no to low evidence to support the use of SCT (N=26, 57%). One respondent (2%) reported offering penile botox treatment while 19 (41%) reported that there was no to low evidence to support its use. A minority of survey respondents offered girth-enhancement procedures with three respondents (7%) offering hyaluronic acid. For length-enhancing procedures, eight respondents (17%) offered cosmetic scrotoplasty and three (7%) offered suprapubic lipectomy. Conclusions Penile regenerative and aesthetic therapies are not common practice among SMSNA members. With the notable exception of fSWT, majority of survey respondents felt that there was little to no evidence supporting penile regenerative and aesthetic therapies. Further understanding the practice patterns of SMSNA members will help identify future opportunities for multi-institutional collaborations to further evaluate the efficacy of these experimental therapies. Disclosure No.

(203) Awareness of Monkeypox Virus Among International Urology Faculty and Trainees is Low: Implications for Early Recognition and Diagnosis

Abstract Introduction The recent international outbreak of Monkeypox virus (Mpox), has raised concerns regarding the recognition and management of this disease among healthcare professionals. The genitourinary presentation of Mpox as variable cutaneous lesions poses a unique challenge for Urologists in its prevention, diagnosis, and management. Objective To assess the understanding and recognition of Mpox among international urologists and urology trainees. Methods A survey relating to the presentation, transmission, and management of Mpox was distributed to urologists and urology trainees during the joint 23rd Sexual Medicine Society of North America (SMSNA)/ 23rd International Society for Sexual Medicine (ISSM) conference. Results Out of 960 attendees, 97 (10.1%) responded to the survey. The rate of respondents who correctly identified a Mpox lesion from a series of cutaneous lesions was 25.8%. A similarly low number of respondents were able to identify the likelihood of having anogenital lesions and oral bleeding on presentation with Mpox at 15.5% and 19.6% respectively. A higher number of respondents accurately noted that diagnosis of Mpox may be made with PCR (79.4%) and that men with multiple male sexual partners are at the highest risk of transmission (72.2%) (Table 1). Conclusions When surveyed regarding the presentation, transmission, and management of Mpox, urologists and urology trainees were generally unable to accurately identify Mpox from a series of cutaneous lesions or the rate at which Mpox may present with anogenital lesions. The limited recognition of its presentation, appropriate diagnostic methods, and distinguishing features from sexually transmitted lesions raises concerns about potential missed diagnoses and delayed treatment. Continued education within the urology community may be necessary for the appropriate detection of and intervention against Mpox. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Antares Pharma, Clarus Therapeutics.

(175) Readability Assessment of Online Men's Health Education Materials from the Sexual Medicine Society of North America, Urology Care Foundation, and European Association of Urology

Abstract Introduction The use of online health information by patients has gained considerable attention during the last decade. With this attention has come exponential adoption towards online resources. Existing literature has shown that a significant majority of patient education materials (PEM) available online exceed the literacy and comprehension of the audience reading them. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources targeted towards a fifth to seventh grade reading level. As the rise of mens health and sexual health continues to grow, understanding what resources may currently exist and how they meet or fail to meet patients needs is of growing concern. Objective We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA), American Urological Association and European Urological Association websites. Methods Content published under the web-section “SMSNA: For Patients - conditions and topics” portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index. Results SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p<0.05) and 12th (p=0.854) grade reading levels, respectively. Conclusions Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support. Disclosure No

(402) Analysis of Peyronie’s Disease Injection Techniques

Abstract Introduction Collagenase clostridium histolyticum (CCH) is the only food and drug administration (FDA) approved intralesional medication for Peyronies Disease (PD). The manufacture instructions recommend a single injection into the plaque at the point of maximal curvature. However, a 2019 survey of the Sexual Medicine Society of North America (SMSNA) found that physicians were utilizing many different injection techniques. It is unknown if one technique is superior. Objective To assess delivery of medication into PD plaques using an invitro model. Methods We obtained PD plaques from men undergoing plaque excision and grafting. Plaques were stored at -80C until ready for use in the lab. We injected the plaques with 0.25ml of Eosin Y, 5 wt. 5% solution in water because this solution is visibly red and similar to the density of CCH. We assess how the dye spread through the plaque in four different injection techniques: single injection, single injection with slow pull back, multiple site injection and lateral injection. All injections were video recorded in real time. Results Dye was retained inside the plaques will all injection techniques, however in all conditions, a significant amount of dye leaked out of the plaques. Multiple injection technique appeared to have the least about of dye leak out of the plaque. Conclusions In all conditions, dye leaked out of the plaques, however the multiple injection technique appears to have deliver the greatest amount Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals

(348) Implementation of Opioid- Free and Opioid-Reduced Protocols for Postoperative Pain Management After Penile Prosthesis Surgery

Abstract Introduction Postoperative pain management after (PP) penile prosthesis is challenging and it has traditionally required opioid medication. In light of the ongoing nationwide opiate epidemic and in an effort to reduce the risk of postoperative opioid dependence, urologic prosthetic surgeons have sought to establish opioid-free and/or opioid-reduced protocols (OFP, ORP respectively) for PP postoperative pain management. Objective This study seeks to investigate the patterns of adoption of OFP or ORP among surgeons who perform PP surgery and potential barriers to their implementation. Methods A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) via email. The survey was administered via Qualtrics. T-test was used to analyze survey responses. Results 43 urologists responded to the survey, with representation from every American Urologic Association geographic section. Most respondents (73.18%) performed penoscrotal PP and 43% of respondents performed more than 30 PP per year. OFP was used most of the time by 24.39% of respondents and ORP was used most of the time by 73.18%. No significant relationship was found between the use of an OFP/ORP and geographical region, number of implants performed per year, surgical approach, or location of reservoir placement. Of the respondents using an ORP, 100% prescribed 10 doses of opioid medication or less upon discharge. 41.51% of respondents used an OFP/ORP from published literature and 9.43% consulted their local anesthesia or pain management department. The most commonly used modalities of non-opioid analgesia were: non-steroidal anti-inflammatories (95.1%), acetaminophen (87.8%), dorsal penile block (80.4%), gabapentin (46.3%), and pudendal block (43.9%). Following initiation of an ORP/OFP, 9.3% reported an increase in phone calls and 11.6% reported an increase in refill requests. There were no reports of increased patient dissatisfaction. Most respondents (65.8%) were extremely satisfied with their protocols. Conclusions OFP/ORP after PP surgery appear to be widely adopted by the urologic prosthetic community without a significant increase in patient or surgeon dissatisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast (ASB).

PD42-05 DOES PENOSCROTAL DECOMPRESSION OUTPERFORM CORPOROGLANULAR TUNNELING FOR SURGICAL MANAGEMENT OF PROLONGED ISCHEMIC PRIAPISM?

You have accessJournal of UrologyCME1 Apr 2023PD42-05 DOES PENOSCROTAL DECOMPRESSION OUTPERFORM CORPOROGLANULAR TUNNELING FOR SURGICAL MANAGEMENT OF PROLONGED ISCHEMIC PRIAPISM? Maia E. VanDyke, Wesley J. Smith, Brian T. Langford, Benjamin N. Breyer, Faysal A. Yafi, David W. Barham, Niels V. Johnsen, Levi C. Holland, Benjamin M. Dropkin, Mikkel Fode, Bryce P. Franzen, Steven J. Hudak, and Allen F. Morey Maia E. VanDykeMaia E. VanDyke More articles by this author , Wesley J. SmithWesley J. Smith More articles by this author , Brian T. LangfordBrian T. Langford More articles by this author , Benjamin N. BreyerBenjamin N. Breyer More articles by this author , Faysal A. YafiFaysal A. Yafi More articles by this author , David W. BarhamDavid W. Barham More articles by this author , Niels V. JohnsenNiels V. Johnsen More articles by this author , Levi C. HollandLevi C. Holland More articles by this author , Benjamin M. DropkinBenjamin M. Dropkin More articles by this author , Mikkel FodeMikkel Fode More articles by this author , Bryce P. FranzenBryce P. Franzen More articles by this author , Steven J. HudakSteven J. Hudak More articles by this author , and Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged ischemic priapism (PIP) presents a rare and challenging urological condition, often requiring advanced surgical maneuvers for resolution. We sought to evaluate current practice patterns in the management of this challenging condition using a multi-institutional survey. METHODS: A 38-question, web-based survey was distributed to clinically active urologic surgeons including members of the Society of Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA). PIP was defined as priapism duration of at least 24 hours prior to presentation. Questions highlighted experience with and perceived efficacy of adjunctive maneuvers including distal shunting, corporoglanular tunneling (CGT) and penoscrotal decompression (PSD). Also queried were surgeons’ impressions of the prevalence of erectile dysfunction after priapism surgery. RESULTS: One hundred fifteen responses were received following survey distribution. Tunneling procedures (CGT and PSD) were the favored first-line intervention for PIP over implants (80/114 tunneling vs. 11/114 implant, p<.001). Respondents were more likely to have performed CGT than PSD (110/113 for CGT vs. 74/112 for PSD, p<.001), but among those who had performed both, PSD was felt to be more than twice as effective at resolving PIP (33/63, 52% Very or Extremely Effective for PSD, vs. 13/64, 20% for CGT; p<.001, Figure 1). For patients with recurrent priapism after CGT, PSD was the preferred salvage procedure for 46% of surgeons (46/99) while immediate implant was favored by 40% (40/99, p=.390). Regarding sexual function, a similar number of respondents who had performed both tunneling procedures felt that at least half of patients regained adequate sexual function after either CGT or PSD (27/61, 44% vs. 25/60, 42%; p=.773). CONCLUSIONS: PSD is perceived by surgeons as more effective than CGT for prolonged ischemic priapism and is commonly chosen as a salvage procedure when CGT fails. Many surgeons feel that patients regain erectile function after tunneling procedures, avoiding the need for expensive prosthetics. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1112 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maia E. VanDyke More articles by this author Wesley J. Smith More articles by this author Brian T. Langford More articles by this author Benjamin N. Breyer More articles by this author Faysal A. Yafi More articles by this author David W. Barham More articles by this author Niels V. Johnsen More articles by this author Levi C. Holland More articles by this author Benjamin M. Dropkin More articles by this author Mikkel Fode More articles by this author Bryce P. Franzen More articles by this author Steven J. Hudak More articles by this author Allen F. Morey More articles by this author Expand All Advertisement PDF downloadLoading ...

Current Landscape of Andrology Fellowship Programs and the Effect of Gender on Post-Fellowship Practice Patterns

ObjectiveTo evaluate the current landscape of andrology fellowships, characteristics of past fellows, and post-fellowship career paths of fellowship graduates. Material and methodsThe websites of the American Urological Association (AUA), Society for the Study of Male Reproduction (SSMR), and Sexual Medicine Society of North America (SMSNA) were reviewed for sponsored fellowships. Program coordinators, institutional websites, and Google were queried for information about each program in a stepwise fashion. Descriptive statistics and t-tests were used to compare outcomes by gender. ResultsThe SMSNA endorsed 73% of programs, and SSMR 48%, while only 45% of all programs participated in the 2021 AUA match. Nearly all programs (93%) were affiliated with an academic institution. Only 20% programs had any female andrology faculty. From 1982-2020, 324 andrology fellows were identified, 16.4% of whom were female. Of the fellows identified, 54.5% of women pursued academia versus 45.5% of men (P = .39). Men and women were equally likely to advertise an exclusive andrology practice, 65.4 and 61.4%, respectively (P = .78). There was an increase in the proportion of female fellows from 8.1%-20.7% when comparing fellows who began training prior to 2010 to those who began training in 2010 or later (P = .0038). ConclusionNational societies have taken steps towards standardizing andrology fellowship training, but much of the fellowship information is not readily available, restricting the interpretation of gender-based differences in practice environment. However, we found that there was no negative impact in female andrologists’ ability to practice andrology or enter academic careers despite being in a male-dominated subspecialty.

Effect of Gender on Practice Patterns of Andrology Fellowship Graduates

ABSTRACT Introduction Women in urology are more likely than their male counterparts to treat a majority female patient population, despite training in non-urogynecologic fellowships. Female urology is accordingly one of the most popular fellowship training choices for female urology residents, while less is known about the traditionally male-dominated subspecialties. Objective We sought to evaluate the current landscape of male reproductive and sexual medicine fellowships as well as characteristics of past andrology fellows and post-fellowship career paths. Methods The websites of the American Urological Association (AUA), Society for the Study of Male Reproduction (SSMR), and Sexual Medicine Society of North America (SMSNA) were reviewed for sponsored fellowships. Program coordinators and institutional websites were queried for information including length of training, curriculum, faculty, current and past fellows. A Google search was performed for each institution in combination with the keywords “male reproduction”, “sexual medicine”, “male infertility”, “prosthetics” and “fellowship” to identify former fellows not listed on institutional websites. Medical school, residency program, current employment, and conditions treated as advertised online were noted. Descriptive statistics and t-tests were used to compare outcomes by gender. P values &amp;lt;0.05 were considered statistically significant. Results The SMSNA endorsed 73% of programs (29/40), and SSMR 48% (19/40) while only 45% of all programs (18/40) participated in the 2021 AUA match. Median length of training was 1 year. Median number of fellowship faculty was 2. Only 20% (8/40) programs had any female andrology faculty. The earliest reported fellows dated back to 1982. From 1982-2021, 324 andrology fellows were identified, 53 of whom were female (16.4%). Of the fellows identified, 43.2% (140/324) were currently working in in an academic position, with 54.5% of women pursuing academia versus 45.5% of men (p=0.39). Men and women were equally likely to advertise an exclusive andrology practice, 65.4 and 61.4%, respectively (p=0.78) versus also seeing general urology indications. We assessed for a change in the proportion of female versus male fellows over time by comparing fellows who began training prior to 2010, and those who began training in 2010 or later. The number of andrology fellows increased from 111 to 213 (91.9%), with an increase in the proportion of female fellows from 8.1% to 20.7%, p=0.0038. Conclusions Less than half of andrology fellowships participate in the AUA match and over a quarter are not endorsed by the SMSNA. Only 1 in 5 fellowship programs had a female faculty member. Male andrology fellows were and remained in the majority over time. Despite this, female andrologists were equally likely to pursue academic careers. National urology and andrology societies have taken steps towards standardizing andrology fellowship training however much of the information is not easily available for residents to view. The limited information on fellowship graduates somewhat restricts interpretation of gender-based differences in practice environment. However, we found there was no negative impact in female andrologists’ ability to practice andrology or enter academic careers despite being in a male-dominated subspecialty. While encouraging, further work is needed by andrology societies to make program information accessible to all trainees and standardize the application process. Disclosure No

Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature

ABSTRACT Introduction The small diameter penile implant (SDPI) is a modified IPP with a smaller diameter cylinder utilized in cases of anatomically small corpora or severe corporal fibrosis. SDPIs allow for patients to obtain useable erections, sometimes with the intent to upsize in the future. There is a dearth of literature on the optimal clinical scenarios for utilization of SDPIs, volume of SDPIs placed nationwide, and patient satisfaction results. Objective Our aim is to identify current usage patterns and perceived patient satisfaction of SDPIs among urologic prosthetic surgeons. Methods A 23-question online survey was distributed via email to physician members of the Sexual Medicine Society of North America (SMSNA) and Society of Urologic Prosthesis Surgeons (SUPS). The survey included questions regarding surgeon experience and volume, frequency of SDPI utilization, indications for SDPI, surgical strategy in the setting of SDPI (approach, use of concordant modeling/grafting), reservoir and pump management, and perceived infection risk and patient satisfaction. Results 50 individuals responded to the survey, 48 of whom routinely utilized SDPIs. The most common indication for SDPI placement was corporal fibrosis from prior infection, followed by anatomically small corpora and priapism. The most common maximal dilation diameter was 10 mm (47%), with an additional 23% of respondents utilizing SDPI with 11 mm dilation. 75.4% of respondents sometimes or always intended to upsize to standard diameter cylinders in the future. 68.8% of surgeons routinely counseled patients on the possibility of reduced girth and rigidity with SDPI. Patient satisfaction was perceived to be comparable to standard diameter cylinders in 56.3% of respondents, while the remaining 43.6% believed it to be lower than traditional cylinders. Conclusions SDPI are utilized by prosthetic surgeons in a variety of clinical situations and are frequently effective. Future research is needed to better characterize patient satisfaction and define which patients are best suited for SDPI. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature.

BackgroundInflatable penile prostheses (IPPs) with smaller diameter cylinders have been in use for over 30 years, yet the literature is sparse on their utilization patterns amongst prosthetic surgeons.AimTo understand current usage of small diameter penile implants (SDPI) among prosthetic surgeons.MethodsIRB approval was obtained to conduct a survey of prosthetic surgeons. A 23-question online survey was distributed via email to physician members of the Sexual Medicine Society of North America (SMSNA) and Society of Urologic Prosthesis Surgeons (SUPS). The survey included questions regarding surgeon experience and volume, frequency of SDPI utilization, indications for SDPI, surgical strategy in the setting of SDPI (approach, use of concordant modeling/grafting), reservoir and pump management, and perceived infection risk and patient satisfaction.Main Outcome MeasureSDPI were utilized by the vast majority of respondents in certain clinical situations such as corporal fibrosis or anatomically small corpora, and surgeons have had a favorable experience with these as a final destination implant or as a place-holder until reimplantation with a normal diameter device.ResultsFifty individuals responded to the survey, 48 of whom routinely utilized SDPI. The most common indication for SDPI placement was corporal fibrosis from prior infection, followed by anatomically small corpora and priapism. The most common maximal dilation diameter was 10 mm (47%), an additional 23% of respondents utilized SDPI with 11 mm dilation. 75.4% of respondents sometimes or always intended to upsize to standard diameter cylinders in the future. 68.8% of surgeons routinely counseled patients on the possibility of reduced grith and rigidity with SDPI. Patient satisfaction was perceived to be comparable to standard diameter cylinders in 56.3% of respondents, while the remaining 43.6% believed it to be lower than traditional cylinders. Utilization of SDPI can be an important tool for prosthetic surgeons faced with difficult cases due to corporal fibrosis or small corpora. This survey provides new insight into patterns of SDPI utilization by surgeons. A limitation of the study is that patient satisfaction is indirectly addressed through surgeons’ perception and experience, further research will be necessary to include patient questionnaires regarding device satisfaction.ConclusionSDPI are necessary in certain scenarios that preclude the use of normal diameter cylinders. These implants may offer satisfactory erections, but can also be upsized to standard diameter cylinders in the future.Campbell SP, Kim CJ, Allkanjari A et al. Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature. Sex Med 2022;10:100458.

MP27-10 SIMPLIFYING THE IDENTIFICATION OF POST-ORGASMIC ILLNESS SYNDROME THROUGH THE DEVELOPMENT OF AN IN-OFFICE SURVEY TOOL

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-10 SIMPLIFYING THE IDENTIFICATION OF POST-ORGASMIC ILLNESS SYNDROME THROUGH THE DEVELOPMENT OF AN IN-OFFICE SURVEY TOOL Caleb Natale, Hoang Minh Tue Nguyen, Andrew Gabrielson, and Wayne Hellstrom Caleb NataleCaleb Natale More articles by this author , Hoang Minh Tue NguyenHoang Minh Tue Nguyen More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , and Wayne HellstromWayne Hellstrom More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-orgasmic illness syndrome (POIS) is a rare syndrome of unknown etiology in which patients experience physical and psychological sequelae after orgasm. Medical professionals are unlikely to be familiar with POIS, and thus a standard intake tool would be of benefit to aid in diagnosis and characterization of disease burden in patients who present with suspicion for the condition. Our aim is to develop a simple disease-specific questionnaire to help guide therapeutic intervention. METHODS: Survey domains and question items were generated after analysis of existing literature in addition to the results of an online survey of 302 participants and five in-depth patient interviews. Survey items were reviewed by a panel of four Urologists with experience treating patients with POIS. Survey items were then evaluated by 3 patients suffering from POIS during cognitive interviews. The expert panel re-evaluated the survey for appropriateness. Question items were then pre-tested on 6 patients suffering from POIS. RESULTS: Survey domains included each of the five diagnostic criteria of POIS as well as measures of disease burden. Disease burden items examined impacts to romantic, sexual, physical, and psychological aspects of patients’ lives. A total of 11 domains and 27 question items were initially proposed for the survey. Eight questions were modified, 2 were deleted and 5 questions were added. The expert panel concluded that 30 total question items were appropriate, accurate and interpretable. The panel decided that the question items adequately sampled these domains. Cognitive interviews resulted in the modification of 12 questions and survey instructions for clarity. CONCLUSIONS: This in-office survey instrument represents a quick and easy method of obtaining standard information concerning POIS symptoms and disease burden. Further investigation is necessary to validate this survey instrument. Source of Funding: Sexual Medicine Society of North America (SMSNA) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e475-e475 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caleb Natale More articles by this author Hoang Minh Tue Nguyen More articles by this author Andrew Gabrielson More articles by this author Wayne Hellstrom More articles by this author Expand All Advertisement Loading ...

PD28-07 ONLINE ACCESS TO PENILE PROSTHETIC SURGEONS: THE CHALLENGE OF FINDING A SPECIALIST

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (PD28)1 Apr 2020PD28-07 ONLINE ACCESS TO PENILE PROSTHETIC SURGEONS: THE CHALLENGE OF FINDING A SPECIALIST Caleb Cooper*, Richard Fantus, Brian Helfand, Robert Brannigan, Nelson Bennet, and Joshua Halpern Caleb Cooper*Caleb Cooper* More articles by this author , Richard FantusRichard Fantus More articles by this author , Brian HelfandBrian Helfand More articles by this author , Robert BranniganRobert Brannigan More articles by this author , Nelson BennetNelson Bennet More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000892.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: When performed by experienced urologists, penile prosthesis implantation has lower infection and reoperation rates. Recent literature suggests that the Internet has become an increasingly popular source of information for patients regarding erectile dysfunction. We examined internet search results to understand the ease with which patients can identify a penile prosthetic specialist online. METHODS: An internet search was conducted using the term "penile prosthesis surgeon <state>" for all 50 states and Washington, DC. The first ten results (i.e. first page) of each search were evaluated for website type, practice type (individual or group-based), academic or private-practice affiliation, and Sexual Medicine Society of North America (SMSNA) affiliation. Descriptive statistics were used to summarize the findings. We examined search position rank (1-10) to determine the likelihood of finding a SMSNA-affiliated provider. RESULTS: A total of 510 search results were obtained, with 508 leading to active sites. Of these sites, 72 (14.1%) were links to individual urologists, 123 (24.2%) to group-based urologists, 46 (9.0%) to out-of-state providers, and 13 (2.8%) to non-urologist providers. An additional 25.7% led to directory sites, 9.8% to academic articles, 12.6% to non-academic and news articles, and 1.8% to industry-related websites. Of the results that linked to urologists, 20.6% had an academic-affiliation and 79.4% were non-academic or private-practice affiliated. A total of 39.3% of the individual and group-urologist results linked to a SMSNA member provider. The mean search position for SMSNA-affiliated results was 5.5 ±2.8. Of all search results in a top-3 position, only 28 (18%) of the results represented SMSNA member urologists. CONCLUSIONS: For many people, the search for goods & services begin online. In fact, 80% of Internet users have searched for health-related topics online. Interestingly, we found less than 50% of internet search results linked to a urologist specializing in penile prosthetics. Furthermore, less than a quarter of all top-3 search results led to an SMSNA-affiliated urologist. Our data show that there is a need for an online, centralized, search-optimized, continually updated database that will provide prospective patients with information & realistic expectations in the area of penile prosthetics. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e614-e614 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caleb Cooper* More articles by this author Richard Fantus More articles by this author Brian Helfand More articles by this author Robert Brannigan More articles by this author Nelson Bennet More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual Health Care Practitioners' Evaluation of Men Who Have Sex With Men

BackgroundThe Institute of Medicine Report and Department of Health and Human Services Healthy People 2020 Initiative have called for steps to address health disparities facing sexual minorities. AimWe sought to characterize the practice patterns of sexual health specialists as they relate to men who have sex with men (MSM). MethodsSurveys were electronically mailed to 696 members of the Sexual Medicine Society of North America (SMSNA). Responses were compared using descriptive statistics and χ2 analysis with Yates correction where appropriate. OutcomesOutcomes were SMSNA members' demographics, their assessment of their patients' sexual orientation, and adaptation of care to address the specific needs of their MSM patients. Results92 (13.2%) Members responded. While 93.3% of respondents reported treating MSM patients, only 51.7% routinely asked about sexual orientation. Of those that do not ask, 41.9% responded that sexual orientation is irrelevant to their patients' care and 25.6% responded that patients will disclose this information if the patient thinks it is important. Practitioners inquiring about sexual orientation were more likely to practice in urban settings; more likely to inquire about a greater number of sexual behaviors; more likely to tailor their care to lesbian, gay, bisexual, and transgender needs; and more likely to endorse the notion that homosexual/bisexual patients have unique sexual dysfunction concerns. Clinical TranslationLimited and uneven inquiry about sexual orientation necessitates efforts aimed at tailoring care to the needs of sexual minority patients. Strengths & LimitationsThis survey addresses a gap in the literature by investigating predictors and practical consequences of practitioner inquiry about sexual orientation.Limitations include a low response rate, disparate study population, the potential influence of respondent social desirability biases, and spurious associations due to a multiplicity of statistical tests. ConclusionOnly about half of surveyed SMSNA members ask their patients' sexual orientation; inquiry about sexual orientation was associated with practice setting and with provider practice patterns and attitudes.Saheb Kashaf M, Butler PR, Cordon-Galiano BH, et al. Sexual Health Care Practitioners' Evaluation of Men Who Have Sex With Men. J Sex Med 2018;15:942–946.

Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation

BackgroundIntraoperative urethral injury is an uncommon event during the placement of a penile prosthesis, and alternative management strategies have been proposed with continuation of implantation after urethral injury. AimTo evaluate surgeon practices in the management of intraoperative urethral injury. MethodsAn online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with penile prosthesis implantation, and management of urethral injuries during prosthesis placement. The response data were analyzed using SAS 9.4 (SAS Institute, Cary, NC, USA). The χ2 test and Fisher exact test were used to determine associations between variables. OutcomesSurvey responses. Results131 survey responses were analyzed. Of the responders, 41.2% were GURS fellowship trained, 19.1% were SMSNA trained, 30.5% were non-fellowship trained, and 9.2% were trained in other fellowships. 25.4% of participants performed more than 50 implantations per year, 37.7% performed 20 to 50 per year, and 36.9% performed fewer than 20 per year. Urethral injury during prosthesis implantation was uncommon, with 26.2% reporting 0 injury, 58.5% reporting 1 to 3 injuries, and 15.4% reporting more than 3 career injuries. Injuries were most commonly encountered during corporal dilation (71.1%) compared with corporal exposure (12.5%) or penile straightening maneuvers (7.0%). There was no statistically significant difference with aborting or continuing implantation among GURS-trained, SMSNA-trained, other fellowship-trained, and non–fellowship-trained surgeons. Of all responders, 55% would abort the procedure after distal urethral injury, whereas 45% would continue the procedure with unilateral or bilateral insertion of cylinders. Patient factors that increased likelihood of terminating the procedure in the case of urethral injury included immunosuppression, spinal cord injury, and clean intermittent catheterization dependence. Clinical ImplicationsA urethral injury during penile prosthesis implantation might not mandate termination of the procedure despite classic teaching. Strengths and LimitationsThe strength of this study is that it provides difficult to obtain epidemiologic data on the frequency and management of this clinically significant injury. Limitations include the inherent biases from a survey-based study including response bias and recall bias. The survey response rate could not be obtained. ConclusionUrethral injury during penile prosthesis implantation is a rare but clinically significant risk of the procedure, with many variations in management of the injury. Termination and delayed implantation might not be necessary after injury, although long-term outcome data are difficult to obtain.Sexton SJ, Granieri MA, Lentz AC. Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation. J Sex Med 2018;15:576–581.

201 Survey on the Contemporary Management of Intraoperative Urethral Injuries during Penile Prosthesis Implantation

Intraoperative urethral injury is an uncommon event during the placement of an inflatable penile prosthesis (IPP) with an estimated incidence of up to 3%. The conventional teaching is to perform primary repair, place a transurethral catheter, and abort the procedure. Recently, alternative management strategies have been proposed with continuation of the implant following urethral injury. The objective of this study is to evaluate surgeon practices in the management of intraoperative urethral injury and determine if fellowship training influences management. An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and The Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with IPP implantation, and management of urethral injuries during IPP placement. The response data was analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC). Chi-squared test and Fisher's exact test were used to determine associations between variables.

MP25-19 SURVEY ON THE CONTEMPORARY MANAGEMENT OF INTRAOPERATIVE URETHRAL INJURIES DURING PENILE PROSTHESIS IMPLANTATION

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I1 Apr 2017MP25-19 SURVEY ON THE CONTEMPORARY MANAGEMENT OF INTRAOPERATIVE URETHRAL INJURIES DURING PENILE PROSTHESIS IMPLANTATION Stephanie J. Sexton, Michael A. Granieri, and Aaron C. Lentz Stephanie J. SextonStephanie J. Sexton More articles by this author , Michael A. GranieriMichael A. Granieri More articles by this author , and Aaron C. LentzAaron C. Lentz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.769AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative urethral injury is an uncommon event during the placement of an inflatable penile prosthesis (IPP) with an estimated incidence of up to 3%. The conventional teaching is to perform primary repair, place a transurethral catheter, and abort the procedure. Recently, alternative management strategies have been proposed with continuation of the implant following urethral injury. The objective of this study is to evaluate surgeon management of urethral injury during IPP and determine if fellowship training influences practice. METHODS An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and The Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with IPP and urethroplasty, IPP surgical approach, and management of urethral injuries during IPP implantation. The response data was analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC). Chi-squared test and Fisher's exact test were used to determine associations between variables. RESULTS There were a total of 131 survey responses. Of the responders, 41.2% were GURS fellowship trained, 19.1% were SMSNA trained, 30.5% were non-fellowship trained, and 9.2% trained in other fellowships. 25.4% of participants perform >50 IPPs per year, while 37.7% perform 20-50 and 36.9% perform fewer than 20 per year. Urethral injury during IPP implantation was uncommon, with 26.2% reporting 0 injuries, 58.5% reporting 1-3 injuries, and 15.4% reporting >3 career injuries. Injuries were most commonly encountered during corporal dilation (71.1%), compared to corporal exposure (12.5%), or penile straightening maneuvers (7.0%). There was no statistically significant difference with aborting or continuing implantation among GURS, SMSNA, and/or non-fellowship trained surgeons. Of all responders, 55% abort the procedure after distal urethral injury, while 45% continue the procedure with unilateral or bilateral insertion of cylinders. For those who chose to abort the procedure, the next implant was attempted in <6 weeks in 9.3%, 6-12 weeks in 45.7%, and >12 weeks in 41.1%. Patient factors that increased likelihood of aborting procedure in the case of urethral injury included immunosuppression, spinal cord injury, and clean intermittent catheterization-dependence. CONCLUSIONS Urethral injury during IPP implantation is a rare but established risk of the procedure. Fellowship training does not appear to have an effect on intraoperative management of this injury. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e318 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stephanie J. Sexton More articles by this author Michael A. Granieri More articles by this author Aaron C. Lentz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Testosterone Pellet Implantation Practices: A Sexual Medicine Society of North America (SMSNA) Member Questionnaire

IntroductionThere has been renewed interest in the use of subcutaneous testosterone pellets for the treatment of hypogonadism since the introduction of Testopel in 2008 by Slate Pharmaceuticals (Durham, NC, USA). Manufacturer guidelines recommend using two to six pellets; however, in the clinical setting, this is deemed insufficient. This has produced a wide variety of testosterone pellet usage that is not fully understood. AimTo better understand subcutaneous testosterone pellet implantation practices among members of the Sexual Medicine Society of North America (SMSNA). MethodsA 19-item questionnaire was emailed to the 687 members of the SMSNA. Of the 19 questions, 17 were multiple choice and two required write-in responses. Usage patterns, satisfaction rates, and complication rates were investigated. Main Outcome MeasuresData regarding indications for initiating treatment with Testopel, initial dosage, follow-up of testosterone levels and dose titration, patient tolerance and satisfaction, technique of implantation, and procedural complications were collected. ResultsEighty-seven survey responses were received (12.9%). At initiation of Testopel therapy, 80.5% of respondents would implant at least 10 pellets, whereas only 4.6% would place six to seven pellets and 3.4% would implant fewer than six pellets. Many respondents would determine the starting dose based on some combination of baseline testosterone level and weight, although 24.1% described using a standard starting dose for all patients. All respondents would check testosterone levels within 3 months of initiating therapy, with the vast majority (72.4%) doing so at 1 month. Subsequent dosing of Testopel was not changed in most patients, with 41.4% and 26.4% of respondents reporting that 60% to 80% and 80% to 100% of patients, respectively, remained on their initial dose. Most respondents would re-implant pellets at a 3-month (21.8%) or 4-month (43.7%) interval. High patient satisfaction was described by respondents, with 56.3% finding patients to be satisfied “most times” and 34.5% “almost always.” ConclusionThis study provides insight into the usage of Testopel among members of the SMSNA. We found that the vast majority of specialists use at least 10 pellets at initial implantation, with limited need for subsequent dose adjustments, good durability of response, and high patient satisfaction and tolerability.

Results of SMSNA Survey Regarding Complications Following Intralesional Injection Therapy With Collagenase Clostridium Histolyticum for Peyronie's Disease.

Intralesional injection of collagenase clostridium histolyticum (CCH) for Peyronie's disease (PD) can result in serious adverse events such as hematoma formation and corporal rupture. To investigate the prevalence of complications from CCH and management trends among CCH prescribers. A survey was sent to all 693 members of the Sexual Medicine Society of North America (SMSNA) with valid email addresses. Responders were asked to participate if they were prescribers of CCH. Data regarding prescriber experience with CCH, procedural preferences, and rates and management strategies of complications were collected. One hundred SMSNA members completed the survey, with 36%, 23%, and 41% of responders having performed ≤10, 10 to 20, and >20 CCH injections, respectively. Of the responders, 94% reported hematomas in <25% of patients, with 63% preferring to observe and 37% treated with a combination of observation, application of a compressive dressing, and/or drainage of the hematoma. Corporal ruptures were encountered by 34% of physicians at a median of 5 days (0.5 to 30 days) from the last CCH injection. Rupture was located over the treated plaque in 84% of cases, and surgical intervention was the preferred management option by 67% of members. A distal circumcising degloving incision was used in 76% of cases, and 62% of responders reported the quality of tissue to be worse than would be expected with a non-CCH penile fracture. There were no significant differences in erectile function, ability to have intercourse, change in penile curvature, and patient satisfaction among patients who underwent surveillance vs surgery. One observed patient developed a penile abscess. A wide variation exists among SMSNA members' strategies to prevent and manage complications of CCH. One in 3 prescribers reported encountering a corporal rupture during CCH therapy, and it is currently undetermined if there is a benefit of surgery vs conservative management.