Sexual Medicine Society Of North America Research Articles

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.

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

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

Testosterone pellet implantation practices: a Sexual Medicine Society of North America (SMSNA) member questionnaire

Testosterone pellet implantation practices: a Sexual Medicine Society of North America (SMSNA) member questionnaire

How is delayed ejaculation defined and treated in North America?

Delayed ejaculation (DE) is an uncommon disorder that is difficult to treat because it is poorly understood. The aim was to evaluate the current opinion and clinical management of DE by practitioners in sexual medicine. Members of the Sexual Medicine Society of North America (SMSNA) were invited by email to participate in a web-based survey. The questionnaire consisted of eight questions pertaining to DE. Questions addressed patient volume, qualification of patient bother, ranking of etiologies, perceived success, treatments used, quantification of symptom resolution, and broad characterization of practitioner type. A total of 94 respondents completed the survey with 73% of those being urologists. Fifty-nine percent of the respondents saw ≤ 2 patients a month with DE and 89% of practitioners felt that DE was moderately or severely bothersome to the patients. Etiology was felt to be from medications and psychological factors primarily. Despite treatment modality, 'seldom' success was obtained for 49% of the time and 'never' for 11%. Carbergoline was the most common selected medication for DE. Academic and private urologists reported 'never' or 'seldom' success with sexual counseling compared to other practitioners, respectively (p = 0.008 and p = 0.001). Respondents who saw ≤ 2 patients per month often reported normalization of hypogonadism 'never' or 'seldom' corrected DE (p = 0.047). Delayed ejaculation is still a poorly understood disorder with inconsistent practice patterns seen among members of the SMSNA. A better understanding of this vexing disorder is needed with efforts placed on research and practitioner education.

President's Message

I am delighted to provide this introduction for this supplement which proudly displays the brilliance of the 19th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America (SMSNA). This publication serves as a compendium of abstracts from the meeting that well represents the contributions of many society members to advance the science and practice of sexual medicine. Let me take this opportunity right now to extend my tremendous thanks to all the contributors, – students, residents, junior investigators, and clinicians young and seasoned, – who participated in this meeting and ensured its success.

Current Opinions on Alternative Reservoir Placement for Inflatable Penile Prosthesis among Members of the Sexual Medicine Society of North America

The Sexual Medicine Society of North America (SMSNA) includes as its members the most experienced prosthetic surgeons in North America who implant inflatable penile prostheses (IPPs). Obliteration of the space of Retzius (SOR) resulting from robotic-assisted laparoscopic prostatectomy (RALP) is a growing concern that has prompted many surgeons to look for alternative locations for reservoir placement during IPP implantation. The aim of this article is to educate the community of prosthetic urologists about potential complications and alternative locations for IPP reservoir placement. A panel of high-volume experienced prosthetic surgeons discussed their views on alternative IPP reservoir implantation during a symposium focused on this topic. After reviewing reservoir complications, physician members of the SMSNA in attendance were surveyed using an audience response system (ARS) to facilitate sharing of knowledge, opinions, and recommendations related to reservoir implantation. Six ARS questions were used to identify the percentages of SMSNA member physicians with concerns about traditional IPP reservoir placement and utilizing alternative reservoir placement (ARP), and the impact of changing practice patterns on patient safety. A majority (81%) of experienced implant surgeons surveyed think that RALP sometimes or frequently makes traditional IPP reservoir placement more difficult. Placement of the reservoir in an alternative location is sometimes or frequently advantageous for patient safety. A vast majority (97%) of the 95 respondents indicated that ARP techniques should be included in physician training courses. Physicians have concerns about reservoir placement in the SOR in RALP patients, which may explain why ARP is popular among SMSNA members. Device manufacturers should support physician training that provides for ARP. Clinical outcomes in RALP patients are needed to better understand the risks and benefits, and define the ideal location of reservoir placement in this population.

Perioperative Prevention of Penile Prosthesis Infection: Practice Patterns among Surgeons of SMSNA and ISSM

Anecdotally, there is great variation in the use of strategies to prevent postoperative penile implant infection. To evaluate the perioperative practice patterns of surgeons who insert penile prostheses focusing on their respective infection control routines. An anonymous Web-based survey was sent to members of the Sexual Medicine Society of North America (SMSNA) and the International Society of Sexual Medicine (ISSM). Thirty-nine questions were asked pertaining to the strategies used during the pre-, intra-, and postoperative phases of penile implant surgery to prevent infection. One hundred twenty-nine surgeons responded to the survey (SMSNA 84; ISSM 45). Most surgeons considered themselves sexual medicine specialists. More SMSNA respondents had inserted >100 prosthesis (SMSNA 69%, ISSM 50%). Routine urine culture is not performed by 40% and 50% of SMSNA and ISSM members, respectively. Similar percentages of surgeons from each society request a daily preoperative antimicrobial scrub. About two-thirds of ISSM members use razors for the preoperative shave compared with one-third of SMSNA members. Most ISSM surgeons preferred povidone-iodine for hand and skin preparation while most SMSNA surgeons chose this only for skin preparation. Two-thirds of SMSNA members prepared the skin for at least 10 minutes compared with 34% of ISSM surgeons. There were considerable differences in all aspects of antibiotic usage not only between members of both societies but also among individual members of each society. Most surgeons prefer not to place a drain (SMSNA 70%, ISSM 81%). Discharge timing differs between the two groups. There is great variation in perioperative strategies utilized to prevent penile implant infections including some key differences between surgeons from SMSNA and ISSM. It is unknown if these variations result in changes in the postoperative infection rate; however, the study data may assist in the formation of practice guidelines and form the basis of future prospective studies.

Controversies in Sexual Medicine: Penile Rehabilitation Should Become the Norm for Radical Prostatectomy Patients

ABSTRACT Introduction The Journal of Sexual Medicine (JSM) held a debate at the annual fall meeting of the Sexual Medicine Society of North America (SMSNA). The motion was “Penile Rehabilitation Should Become the Norm for Radical Prostatectomy Patients.” At the suggestion of several SMSNA members, it was requested that this debate might be of interest to JSM readers in the form of a published controversy. Methods Two debate speakers with expertise and/or strong opinions in the area of penile rehabilitation submitted their literature-review, evidence-based opinions on the topic. Main Outcome Measure Literature review of laboratory basic science and clinical research studies on penile rehabilitation. Results Penile rehabilitation involves prophylactic procedures designed to improve oxygen delivery to penile erectile tissues, aimed at preserving erectile tissue health and minimizing erectile tissue damage that otherwise occurs during the period of neural recovery to the autonomic cavernosal nerve following radical prostatectomy. There are several studies in the sexual medicine literature on penile rehabilitation after radical prostatectomy, and the positive results appear to support this concept, the rationale, and mechanism. The use of prophylactic penile rehabilitation programs has not been fully elucidated, nor have the results been replicated in large multicenter placebo-controlled trials. Conclusion Penile rehabilitation may be performed along with counseling with the couple, vacuum erection therapy, and vacuum erection device therapy if it is the patient and partner's preference, provided that it is undertaken in a safe and effective manner and is monitored closely.

2006 Program Schedule

Anecdotally, there is great variation in the use of strategies to prevent postoperative penile implant infection.To evaluate the perioperative practice patterns of surgeons who insert penile prostheses focusing on their respective infection control routines.An anonymous Web-based survey was sent to members of the Sexual Medicine Society of North America (SMSNA) and the International Society of Sexual Medicine (ISSM).Thirty-nine questions were asked pertaining to the strategies used during the pre-, intra-, and postoperative phases of penile implant surgery to prevent infection.One hundred twenty-nine surgeons responded to the survey (SMSNA 84; ISSM 45). Most surgeons considered themselves sexual medicine specialists. More SMSNA respondents had inserted >100 prosthesis (SMSNA 69%, ISSM 50%). Routine urine culture is not performed by 40% and 50% of SMSNA and ISSM members, respectively. Similar percentages of surgeons from each society request a daily preoperative antimicrobial scrub. About two-thirds of ISSM members use razors for the preoperative shave compared with one-third of SMSNA members. Most ISSM surgeons preferred povidone-iodine for hand and skin preparation while most SMSNA surgeons chose this only for skin preparation. Two-thirds of SMSNA members prepared the skin for at least 10 minutes compared with 34% of ISSM surgeons. There were considerable differences in all aspects of antibiotic usage not only between members of both societies but also among individual members of each society. Most surgeons prefer not to place a drain (SMSNA 70%, ISSM 81%). Discharge timing differs between the two groups.There is great variation in perioperative strategies utilized to prevent penile implant infections including some key differences between surgeons from SMSNA and ISSM. It is unknown if these variations result in changes in the postoperative infection rate; however, the study data may assist in the formation of practice guidelines and form the basis of future prospective studies. Katz DJ, Stember DS, Nelson CJ, and Mulhall JP. Perioperative prevention of penile prosthesis infection: Practice patterns among surgeons of SMSNA and ISSM. J Sex Med 2012;9:1705–1714.

NERI Symposium at 2006 Sexual Medicine Society of North America Meeting

The Journal of Sexual Medicine (JSM) held a debate at the annual fall meeting of the Sexual Medicine Society of North America (SMSNA). The motion was “Penile Rehabilitation Should Become the Norm for Radical Prostatectomy Patients.” At the suggestion of several SMSNA members, it was requested that this debate might be of interest to JSM readers in the form of a published controversy.Two debate speakers with expertise and/or strong opinions in the area of penile rehabilitation submitted their literature-review, evidence-based opinions on the topic.Literature review of laboratory basic science and clinical research studies on penile rehabilitation.Penile rehabilitation involves prophylactic procedures designed to improve oxygen delivery to penile erectile tissues, aimed at preserving erectile tissue health and minimizing erectile tissue damage that otherwise occurs during the period of neural recovery to the autonomic cavernosal nerve following radical prostatectomy. There are several studies in the sexual medicine literature on penile rehabilitation after radical prostatectomy, and the positive results appear to support this concept, the rationale, and mechanism. The use of prophylactic penile rehabilitation programs has not been fully elucidated, nor have the results been replicated in large multicenter placebo-controlled trials.Penile rehabilitation may be performed along with counseling with the couple, vacuum erection therapy, and vacuum erection device therapy if it is the patient and partner's preference, provided that it is undertaken in a safe and effective manner and is monitored closely. Mulhall JP, and Morgentaler A. Penile rehabilitation should become the norm for radical prostatectomy patients.

Premature Ejaculation

The Sexual Medicine Society of North America (SMSNA) hosted a State of the Art Conference on Premature Ejaculation (PE) on June 24–26, 2005, in collaboration with the University of South Florida. Funding for this event was provided by an unrestricted educational grant from Ortho-Urology. The purpose of this conference was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives: