Time Of Inflatable Penile Prosthesis Placement Research Articles

Does climate impact inflatable penile prosthesis infection (IPP) risk? Assessment of temperature and dew point on IPP infections.

Variations in climate have been associated with a greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome; however, limited data exist on the impact of climate on inflatable penile prosthesis (IPP) infections. We sought to evaluate the impact of climate on the risk of IPP infections in a large international, multicenter cohort. We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Implant infections were defined as infections requiring device explantation. A univariate logistic regression analysis was undertaken. Our primary outcome was implant infection. A total of 5289 patients with a mean age of 62.2 ± 10.8years received IPP placement. There was a fairly even distribution of implants performed in each season. A total of 103 (1.9%) infections were recorded. There were 32 (31.1%) IPP infections in patients who underwent surgery in the summer, followed by 28 (27.2%) in the winter, 26 (25.2%) in the spring, and 17 (16.5%) in the fall. No statistically significant differences were recorded in terms of season (P = .19) and month (P = .29). The mean daily temperature (P = .43), dew point (P = .43), and humidity (P = .92) at the time of IPP placement was not associated with infection. These findings provide reassurance to prosthetic urologists that infection reduction strategies do not need to be tailored to local climate. Climate data were not directly recorded for each hospital, but rather based on the monthly averages in the city where the surgery was performed. The climate at time of IPP placement and time of year of surgery is not associated with IPP infection risk.

(187) The SAPOC Technique: Slices Around Point of Maximal Curvature at Time of IPP placement in Severe Peyronie's Disease

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease and erectile dysfunction (ED). Most cases involving plaque incision and graft placement are performed at the point of maximal curvature which result in a large defect that requires placement of a large graft while postoperative penile shortening remains a significant concern among patients. Objective To present a video of a novel modification of the multiple slit technique (MUST) for the treatment of severe PD and ED during IPP placement. This technique involves multiple relaxing incisions made around the point of maximal curvature (POMC) which minimizes the size or even the need of a graft while allowing for length restoration. Methods This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the POMC is identified, 2 to 4 transverse relaxing incisions (slices) are made around the POMC approximately 1 to 1.5cm apart in order to minimize the size of the defect and hence the need or size of the graft. Each slice allows for maximal restoration of length. Results The SAPOC technique results in correction of curvature and length restoration. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex PD and ED. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Boston Scientific and Coloplast.

(171) The Effects of Pretreatment with Xiaflex on Penile Curvature Correction with Manual Modeling During and After IPP placement

Abstract Introduction There are a variety of treatment modalities available to treat Peyronie’s disease (PD), including collagenase clostridium histolyticum (Xiaflex) injections. Patients with concomitant erectile dysfunction (ED) and PD are best served by insertion of an inflatable penile prosthesis (IPP) in order to adequately treat both conditions. Many PD patients may undergo other PD treatments, including Xiaflex, prior to IPP implantation. There are multiple methods of curvature treatment during IPP surgery, and manual modeling is the predominant method in our practice. Little data exists regarding whether Xiaflex treatments prior to IPP placement influence changes in penile curvature during and after IPP surgery with manual modeling. Objective The primary objectives were assessing the impact of pre-treatment with Xiaflex on penile curvature immediately after IPP implantation and after manual modeling. The secondary objective was change in penile curvature post-operatively. Methods All IPP patients with known preoperative penile curvature with and without a history of Xiaflex injections undergoing IPP placement by a single surgeon from January 2017 to June 2023 were included in this IRB-approved (IRB 00031589) retrospective series. All patients had a 3-piece Coloplast Titan Touch IPP (Coloplast, Minneapolis, MN, USA) ranging 16-24cm in length (mean 19.8 ± 1.9cm) with 0-3cm rear tips (mean 1.4 ± 0.9cm). Goniometer was used to assess curvature during preoperative intracavernosal injection and duplex Doppler ultrasound, at multiple points intraoperatively, and postoperatively at 2 weeks, 6 weeks, and 6 months. Biplanar curvatures were recorded as primary and secondary values. SPSS (IBM, Armonk, NY, UA) was used for statistical analyses, which included t-tests, chi-squared tests, and ANOVA. Results Sixty-one patients were included. Preoperative curvature was 35° ± 17° (10° to 70°) for the Xiaflex cohort (n=11) and 41° ± 15° (20° to 80°) for the Xiaflex naïve cohort (n=50). At the time of IPP placement, patients previously treated with Xiaflex had a 19° ± 12° absolute reduction in primary penile curvatures, corresponding to a 45% ± 36% improvement (25° reduction to 5° worsening), while Xiaflex naïve patients had a 20° ± 13° absolute reduction and 54% ± 23% improvement (50° reduction to no change). Similar mean curvature reductions were seen with IPP placement in primary dorsal curves in the Xiaflex cohort (n=7, 21° ± 4°, 51% ± 12%, 25° to 15° reduction) and Xiaflex naïve cohort (n=24, 21° ± 9°, 51% ± 22%, 40° to 5° reduction). There was little difference in change in curvature after modeling between the Xiaflex (11° ± 3°, 63% ± 23%, 15° to 5° reduction) and Xiaflex naïve patients (14° ± 9°, 70% ± 20%, 40° reduction to 5° worsening). Interval assessments postoperatively were also comparable. Sample size precluded assessment of statistical significance among groups. Conclusions Preoperative treatment of PD with Xiaflex does not impede nor significantly improve curvature correction with IPP implantation and manual modeling. Similar changes in penile curvatures were seen in both groups regardless of curvature direction, modeling, or postoperative interval. In patients with severe PD, Xiaflex may be a useful tool to improve preoperative penile curvatures such that they may be more easily correctable with an IPP. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.

Treatment of male stress urinary incontinence at time of inflatable penile prosthesis placement a review of contemporary literature.

Male stress urinary incontinence (SUI) and erectile dysfunction (ED) are well established diagnoses within Men's Health, often more specifically within the prostate cancer survivorship cohort. Taken individually, well defined treatment algorithms exist with which many surgeons are comfortable; however, treatment of both in a single setting or staged fashion introduces complexity. Emerging treatment options also exist, and there is immature or minimal data when these are combined with inflatable penile prosthesis (IPP) insertion, radiation history, and/or variable degrees of incontinence. Our objective was to describe and summarize the currently available treatment options for SUI particularly at the time of IPP insertion. A literature review was performed to summarize contemporary treatment of SUI at time of IPP placement. Anecdotal experience was added from high volume, subspecialty trained Men's Health and Reconstructive Urologists. Non-invasive approaches such as pelvic floor muscle training (PFMT), behavioral modification, and external compression devices play some limited role in treatment and/or management of SUI, particularly in the early post operative period, or for those unwilling or unable to undergo more definitive intervention. More invasive options such as artificial urinary sphincter (AUS) implantation, male sling, or other implantable devices are more appropriate for good surgical candidates with higher bother and/or more severe incontinence. These options can be concomitant or staged relative to IPP placement. Climacturia, particularly with mild or no bothersome SUI, can successfully be addressed at the time of penile prosthesis placement with the utilization of the Mini-Jupette suburethral sling. A variety of treatment options exist for concomitant treatment of SUI at time of IPP, and both safety and efficacy have been demonstrated for many in the same operative setting. As with treatment of ED or SUI in isolation, patient selection, careful counseling, and management of expectations can lead to high patient satisfaction.

The SAPOC technique: A novel approach utilizing multiple slices around point of maximal curvature for the correction of penile curvature at the time of penile prosthesis placement in patients with severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusion The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Consultant for Coloplast and Boston Scientific).

PD28-10 CONCOMITANT UROLOGIC PROCEDURES DURING PENILE PROSTHESIS SURGERY

You have accessJournal of UrologyCME1 May 2022PD28-10 CONCOMITANT UROLOGIC PROCEDURES DURING PENILE PROSTHESIS SURGERY Jason Levy, Ridwan Alam, William Ducomb, and Arthur Burnett Jason LevyJason Levy More articles by this author , Ridwan AlamRidwan Alam More articles by this author , William DucombWilliam Ducomb More articles by this author , and Arthur BurnettArthur Burnett More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a paucity of literature investigating outcomes for patients who undergo concomitant non-reconstructive urologic procedures at the time of 3-piece inflatable penile prosthesis (IPP) placement. Our aim is to analyze outcomes including risk factors, complications, and procedure types for patients who underwent IPP placement with concomitant non-reconstructive urologic procedures at a high-volume institution. METHODS: A retrospective IRB approved (IRB00205900) review of patients undergoing IPP placement at Johns Hopkins from January 2007-July 2021 was conducted. We identified 330 patients who underwent IPP placement and a concomitant urologic procedure. We excluded patients who had concomitant penile straightening procedures, artificial urinary sphincter (AUS), and reconstructive penile procedures. The remaining cohort included 45 patients who had a non-reconstructive urologic procedure done concurrently. A control group of 127 patients who underwent IPP placement after 2015 with no concomitant procedures was utilized. All patients underwent penoscrotal approach. RESULTS: Concomitant procedure type was divided into endourology (n=24; 53.3%), penile (n=9; 20.0%), scrotal (n=10; 22.2%), neuromodulation (n=1; 2.2%), and oncologic (n=1; 2.2%). Compared to the control group, patients in the concomitant group were younger (p=0.04) but more overweight (p=0.02) and less healthy, as measured by comorbidities (p=0.03). Between the two groups (Table 1), there was no significant difference in device infections (concomitant 2.2% vs control 1.6%, p=0.78) or device erosions (4.4% vs 3.2%, p=0.68). There was no difference in the proportion of patients requiring future IPP revision (13.3% vs 10.2%, p=0.50). CONCLUSIONS: This retrospective analysis demonstrates the largest cohort of patients undergoing non-reconstructive urologic procedures at the time of IPP placement. Our results demonstrate that concomitant non-reconstructive procedures confer no increased risk of prosthetic adverse events, regardless of procedure type. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Levy More articles by this author Ridwan Alam More articles by this author William Ducomb More articles by this author Arthur Burnett More articles by this author Expand All Advertisement PDF DownloadLoading ...

The SAPOC Technique: A Novel Approach Utilizing Multiple Slices Around Point of Maximal Curvature for the Correction of Penile Curvature at the Time of Penile Prosthesis Placement in Patients with Severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Coloplast, Boston Scientific, and Endo Pharmaceuticals

The Urethral Microbiome During Inflatable Penile Prosthesis Placement

ABSTRACT Introduction Foley catheter placement prior to inflatable penile prosthesis (IPP) implantation permits drainage of the bladder to ensure safe retropubic reservoir placement and allows for palpation of the urethra to prevent inadvertent injury. The urethra is often colonized with commensal organisms mostly concentrated at the meatus and fossa navicularis to which the Foley catheter is exposed during placement. Following placement, the catheter remains on the sterile field during surgery. Objective We sought to investigate if the microbiome of the urethra could contaminate the Foley catheter during IPP placement. Methods Data was retrospectively reviewed on all patients who underwent three-piece IPP placement at a single institution from 2/2020 to 6/2021. Patient demographics, clinical characteristics, and comorbidities were recorded. Culture swabs from the fossa navicularis and exposed Foley catheter were collected intra-operatively after Foley catheter placement. Growth of aerobic, anaerobic, and fungal organisms was assessed. Univariate analyses with chi-square tests were performed to compare baseline demographic and clinical data with isolation of organisms from culture swabs. Results A total of 50 patients were included in this study. All surgeries were performed via penoscrotal approach by a single surgeon. 22% (n = 11) were revision procedures, all of which were due to mechanical device malfunction. The median age of our cohort was 66.5 years (range: 42-78 years) and 30% (n = 15) had a BMI of 30 kg/m² or greater. Three patients (6%) were current smokers and 46% (n = 23) were diabetic. Two patients (4%) had isolation of aerobic organisms and five patients (10%) had isolation of anaerobic organisms. No patients had isolation of fungal organisms. There was no statistically significant relationship between obese BMI, diabetes diagnosis, or current smoking and the isolation of organisms. Three patients (6%) ultimately developed a device infection; notably, none of these patients had isolation of organisms from their culture swabs at initial implant. Conclusions A number of patients had isolation of aerobic and anaerobic organisms from their intra-operatively collected urethral swabs, but none of these patients have currently shown evidence of a device infection. This is the first study to examine the urethral microbiome and its potential effect on Foley catheter contamination at the time of IPP placement. Further study is needed to determine if this could be a significant source of device infection. Disclosure No

The Clinical Significance of Imperfection: Do Asymmetry or Occult Curvature Matter in Penile Prosthesis Placement?

ABSTRACT Introduction Patient satisfaction after inflatable penile prosthesis (IPP) placement has been linked to preexisting curvature. Intraoperative findings such as curvature on artificial erection (AE) or asymmetric corporal measurements (ACM) are incompletely characterized in terms of impact on IPP outcome. Objective We sought to evaluate the clinical utility of AE and the significance of ACM during IPP surgery. Methods A single institution retrospective review of patients undergoing primary IPP placement between 7/2019-9/2020 was performed. Patient characteristics and intraoperative measurements were compared. Threshold for statistical significance was p≤0.05. Results A total of 130 patients underwent primary placement of penile prosthesis. Median age was 67 years (IQR 13). Comorbidities included prostatectomy in 33.8%, and known Peyronie's disease in 21.5%. Of the 27.7% (n=36) of patients who underwent intraoperative AE, 63.9% (n=23) had visible curvature. Of the patients with visible curvature, 70% (n=16) had a preoperative diagnosis of Peyronie's disease and 56.3% (n=9) underwent straightening procedures compared to 28.6% (n=2) of the 30% (n=7) with no known curvature. Incision and grafting was most frequently performed (6/11)- with a minority undergoing plication (2/11). Of the 72.3% (n=94) who did not undergo AE, only 2.1% (n=2) required additional measures for curvature correction. Median corporal measurement was 21 (IQR 2) bilaterally and median cylinder size 20 cm (IQR 4) bilaterally with 1cm rear tip extenders. Of the 18.5% (24/130) of patients with ACM, asymmetry was as follows: 20.8% (5/24) had less than 1 cm, 70.8% (17/24) had 1 to <2 cm, and 8.3% (2/24) had 2 cm or greater. Of these patients 87.5% (21/24) underwent placement of an asymmetric device, only 5% (1/21) of which had residual curvature less than 30 degrees. Despite ACMs, 12.5% (3/24) of patients had a symmetric device placed, one of which had residual curvature. Only 2 patients underwent straightening procedures including plication and incision/grafting. Conclusions Intraoperative AE is effective at revealing occult penile curvature at time of IPP placement, however most men with newly detected curvature do not require additional straightening measures. We also found that 1 in 5 patients undergoing IPP had ACM but this did not correspond to residual curvature following IPP or requirement for adjunct straightening. These findings may provide reassurance to urologists who do not routinely perform AE or those who encounter ACM during corporal dilation Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast

MP57-06 THE URETHRAL MICROBIOME DURING INFLATABLE PENILE PROSTHESIS PLACEMENT

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy (MP57)1 Sep 2021MP57-06 THE URETHRAL MICROBIOME DURING INFLATABLE PENILE PROSTHESIS PLACEMENT John Williams, Hayden Hill, Eric Wendel, and Eric Laborde John Williams John Williams More articles by this author , Hayden HillHayden Hill More articles by this author , Eric WendelEric Wendel More articles by this author , and Eric LabordeEric Laborde More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002087.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Foley catheter placement prior to inflatable penile prosthesis (IPP) implantation permits drainage of the bladder to ensure safe retropubic reservoir placement and allows for palpation of the urethra to prevent inadvertent injury. The urethra is often colonized with commensal organisms mostly concentrated at the meatus and fossa navicularis to which the Foley catheter is exposed during placement. Following placement, the catheter remains on the sterile field during surgery. We sought to investigate if the microbiome of the urethra could contaminate the Foley catheter during IPP placement. METHODS: Data was retrospectively reviewed on all patients who underwent three-piece IPP placement at a single institution from 2/2020 to 2/2021. Patient demographics, clinical characteristics, and comorbidities were recorded. Culture swabs from the fossa navicularis and exposed Foley catheter were collected intra-operatively after Foley catheter placement. Growth of aerobic, anaerobic, and fungal organisms was assessed. Univariate analyses with chi-square tests were performed to compare baseline demographic and clinical data with isolation of organisms from culture swabs. RESULTS: A total of 40 patients were included in this study. All surgeries were performed via penoscrotal approach by a single surgeon. 20% (n=8) were revision procedures, all of which were due to mechanical device malfunction. The mean age of our cohort was 65 years (range: 42-78 years) and 35% (n=14) had a BMI of 30 kg/m2 or greater. Three patients (8%) were current smokers and 48% (n=19) were diabetic. Two patients (5%) had isolation of aerobic organisms and five patients (13%) had isolation of anaerobic organisms. No patients had isolation of fungal organisms. There was no statistically significant relationship between obese BMI, diabetes diagnosis, or current smoking and the isolation of organisms. No patients have currently shown evidence of device infection. CONCLUSIONS: A number of patients had isolation of aerobic and anaerobic organisms from their intra-operatively collected cultures. This is the first study to examine the urethral microbiome and its potential effect on Foley catheter contamination at the time of IPP placement. Further study is needed to determine if this could be a significant source of device infection. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e980-e980 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Williams More articles by this author Hayden Hill More articles by this author Eric Wendel More articles by this author Eric Laborde More articles by this author Expand All Advertisement Loading ...

Preliminary Outcomes of the Male Urethral “Mini-Sling”: A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence

IntroductionPrevious worked showed that the Andrianne Mini-Jupette (AMJ) procedure with inflatable penile prosthesis (IPP) significantly improves climacturia or stress urinary incontinence (SUI) that may accompany erectile dysfunction (ED) after radical prostatectomy. However, with the AMJ procedure, the graft is incorporated into the medial aspect of the corporotomy, thereby requiring a more complex closure. Moreover, in the original report, multiple graft materials were used. AimTo describe our technique for “male urethral mini-sling” (MUMS) with a Virtue sling mesh, which is a modified approach to the AMJ, and to assess early postoperative outcomes. MethodsA retrospective chart review was performed for men who underwent IPP and MUMS placement with a modified Virtue mesh by 2 high-volume prosthetic urologic surgeons using the same technique. After proximal urethral exposure, the MUMS is sutured to the latera corpora over the bulbar urethra, proximal to and separate from the planned corporotomy, with care taken to avoid excessive urethral tension. The IPP is then placed in standard fashion. Changes in patient-reported climacturia and pads per day for SUI were assessed before and after surgery. Results36 men underwent both IPP and MUMS placement between January 2016–October 2018. Mean patient age was 68 years. Etiology for ED and urinary symptoms was prostatectomy alone in 30 of 36 (83%) and prostatectomy plus radiation in 6 of 36 (17%). Preoperative urinary symptoms included climacturia in 30 of 36 (83%) and SUI in 27 of 36 (75%). Mean (SD) follow-up was 5.9 (3.7) months. Climacturia resolved in 28 of 30 (93%), and SUI improved in 23 of 27 (85%). The mean (SD) number of pads per day for those patients with SUI decreased significantly from 1.4 (1.1) before surgery to 0.4 (0.6) after surgery (P = .02). 1 patient required MUMS explantation for urethral erosion after prolonged postoperative catheterization. Clinical ImplicationsThe MUMS with modified Virtue mesh at the time of IPP placement can be used to treat ED with climacturia or mild SUI after radical prostatectomy. Strengths & LimitationsStrengths include the use of a consistent operative technique with a single graft material by 2 experienced prosthetic urologic surgeons. Limitations include the retrospective study design, use of subjective postoperative outcomes, lack of comparison group, and relatively moderate follow-up duration. ConclusionsOur early results suggest that the MUMS significantly improves bothersome climacturia and mild SUI in addition to treating ED, with little added morbidity. Although further study, including longer-term follow-up, is needed, this approach may be considered in the appropriately counseled patient.Valenzuela RJ, Ziegelmann MJ, Hillelsohn JH, et al. Preliminary Outcomes of the Male Urethral “Mini-Sling”: A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence. J Sex Med 2019;16:1310–1317.

MP67-02 DOES PRE-OPERATIVE PENILE ULTRASOUND HELP WITH SURGICAL PLANNING IN PATIENTS WITH PEYRONIE'S DISEASE AND ERECTILE DYSFUNCTION?

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018MP67-02 DOES PRE-OPERATIVE PENILE ULTRASOUND HELP WITH SURGICAL PLANNING IN PATIENTS WITH PEYRONIE'S DISEASE AND ERECTILE DYSFUNCTION? Dorota Hawksworth, Emad Rajih, Osama Ali, and Arthur Burnett Dorota HawksworthDorota Hawksworth More articles by this author , Emad RajihEmad Rajih More articles by this author , Osama AliOsama Ali More articles by this author , and Arthur BurnettArthur Burnett More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) defined as chronic inflammation of the tunica albuginea, is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. PD affects an estimated 5% of men and results in penile pain, abnormal curvature, penile shortening and/ or erectile dysfunction (ED). About 20-30% of patients with PD have concomitant ED refractory to medical therapy and may benefit from a combined procedure addressing both conditions. Prior reports demonstrate that the majority of patients with PD-type penile deformity required adjunctive corrective procedures (modeling, plaque incision, incision/ excision and grafting) at time of inflatable penile prosthesis (IPP) placement, and only 4% achieved spontaneous curvature correction with IPP placement alone. Our objective is to correlate pre-operative penile examination and penile ultrasound results to intra-operative findings in order to reliably predict need for adjunctive corrective procedures at time of IPP placement. METHODS Prospectively collected database of 898 consecutive records of patients who underwent inflatable penile prosthesis (IPP) placement at our institution between May 2007 and March 2017 was queried. Medical records of patients with concomitant PD and ED diagnoses were further evaluated. Patient demographics, pre-operative workup and intra-operative data were reviewed. Patients with no documented pre-operative penile examination and penile ultrasound were excluded from this review. Based on the complexity of the straightening procedures performed, patients were divided into three sub-categories:1. Mild (modeling only), 2. Moderate (modeling/corporoplasty, corporoplasty alone, corporoplasty/modeling and scar excision alone), 3. Severe (corporoplasty/modeling with Allograft placement, corporoplasty with Nesbit, scar excision/corporoplasty and scar excision with Allograft placement). Standard statistical calculations were utilized. RESULTS Out of 898 patient records, 62 were identified and further reviewed. Average patient's age was 60yo (42-81 yo). 54 out of 62 (87.1%) patients reported a penile deformity at time of pre-operative consultation and 43/60 (71.67%) had an abnormal penile examination consistent with PD. 8 (12.9%) patients with no reported pre-operative curvature and normal exam were diagnosed with penile deformities intra-operatively and necessitated further straightening maneuver(s). Pre-operative examination diagnostic of PD correlated with intra-op findings in 41/60 (68%) of all presenting patients. PPV of an abnormal pre-operative examination was 71.43% with a sensitivity of 93%.39 (62.9%) patients had a pre-operative penile duplex ultrasound performed, and out of those 92.31% demonstrated a penile tissue abnormality suggestive of PD. The ultrasound findings correlated with intra-operative findings in 91.89% of the patients. Four of the six patients requiring the most complex adjunctive corrective procedures had tunical calcifications present on the pre-operative sonographic evaluation. Additionally, those cases prolonged the total operative time by an average of 75 minutes. CONCLUSIONS In our referral population, 13% of patients presenting for IPP placement, who had normal pre-operative penile examination and no reported penile curvature, were observed to have a significant penile curvature intra-operatively and needed a concomitant straightening procedure. Confirmation of a penile tissue abnormality on pre-operative ultrasound has the highest predictive value for need of additional straightening maneuvers during IPP placement in patients with concomitant ED and PD. Penile ultrasonography appears to be a good surrogate for a penile examination, as it has a high sensitivity for detection of PD. Tunical calcifications identified on pre-operative ultrasound help predict necessity of more advanced straightening techniques and additional operative time required to achieve successful surgical outcome. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e907-e908 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dorota Hawksworth More articles by this author Emad Rajih More articles by this author Osama Ali More articles by this author Arthur Burnett More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

331 Does pre-operative Evaluation of Patient with Peyronie's Disease Correspond to Intra-operative Findings and Need for Adjunctive Straightening Procedures at Time of IPP Placement?

To correlate pre-operative penile examination and penile ultrasound results to intra-operative findings in order to reliably predict need for adjunctive corrective procedures at time of IPP placement. Prospectively collected database of 898 consecutive records of patients who underwent inflatable penile prosthesis (IPP) placement at our institution between May 2007 and March 2017 was queried. Medical records of patients with concomitant Peyronie's disease (PD) and erectile dysfunction (ED) diagnoses were further evaluated. Patient demographics, pre-operative workup, intra-operative surgeon observations and additional straightening maneuvers performed at time of IPP placement were reviewed. Patients with no documented pre-operative penile examination and no penile ultrasound were excluded from this review. Simple statistical calculations of means, positive predictive values (PPV), sensitivities and specificities were utilized. Out of 898 patient records, 53 with concomitant diagnostic codes for ED and PD were identified and further reviewed. Average patient's age was 61yo (42-81yo). 45 out of 53 (84.9%) patients reported a penile deformity at time of pre-operative consultation and 33/47 (70%) of them had an abnormal penile examination consistent with PD. 8 (15.1%) additional patients with no reported pre-operative curvature and normal exam were diagnosed with penile deformities intra-operatively and necessitated further straightening maneuver(s). Pre-operative examination diagnostic of PD correlated with intra-op findings in 31/47 (66%) of all presenting patients. PPV of an abnormal pre-operative examination was 93.9% with a sensitivity of 68.9%. 32 (68%) patients had a pre-operative penile duplex ultrasound performed, and out of those 53% demonstrated a penile tissue abnormality consistent with Peyronie's plaque. The ultrasound findings correlated with intra-operative findings only in 43.8% of the patients. Although the PPV of abnormal ultrasound examination was 93.3%, its sensitivity was only 45.2%.

Intraoperative Decision-making for Precise Penile Straightening During Inflatable Penile Prosthesis Surgery

To present a novel algorithm for definitive reconstruction of penile curvature in men undergoing inflatable penile prosthesis (IPP) surgery as an alternative to manual penile modeling and grafting procedures. Patients with erectile dysfunction and concomitant penile curvature undergoing IPP placement were divided into 2 treatment groups: (1) group 1, penile deformity known preoperatively, and (2) group 2, penile curvature recognized intraoperatively after IPP placement. Group 1 patients underwent penile plication after artificial erection and immediately before IPP insertion via the same penoscrotal incision, whereas group 2 patients were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. Patients completed postoperative Patient Global Impression of Improvement (PGI-I) questionnaires assessing overall satisfaction. Among 405 men receiving IPP at our institution from 2007 to 2014, 30 patients received synchronous correction of penile curvature (7%). Group 1 included 23 of 30 (77%) patients, and 7 of 30 (23%) were in group 2. Overall mean initial curvature was 36°, and all patients were corrected to < 10°. Average operative times were 18 minutes longer compared with patients who underwent IPP placement alone (82 vs 64 minutes, P <.05). At an average follow-up of 13 months (range 7-32), 19 of 20 (95%) group 1 and 6 of 7 (86%) group 2 patients who completed surveys reported an improved overall condition. No patient reported chronic pain, recurrent deformity, or device malfunction. Penile curvature can be safely and reliably corrected at the time of IPP placement, regardless of whether the deformity was identified preoperatively.

PD48-09 VERSATILE ALGORITHMIC APPROACH FOR DEFINITIVE STRAIGHTENING WITHOUT MODELING DURING PENILE PROSTHESIS SURGERY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease1 Apr 2015PD48-09 VERSATILE ALGORITHMIC APPROACH FOR DEFINITIVE STRAIGHTENING WITHOUT MODELING DURING PENILE PROSTHESIS SURGERY Timothy Tausch, Paul Chung, Jordan Siegel, Alexandra Klein, and Allen Morey Timothy TauschTimothy Tausch More articles by this author , Paul ChungPaul Chung More articles by this author , Jordan SiegelJordan Siegel More articles by this author , Alexandra KleinAlexandra Klein More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2766AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present a novel algorithm for definitive reconstruction of penile curvature in men undergoing concomitant inflatable penile prosthesis (IPP) surgery as an alternative to penile modeling. METHODS Patients receiving IPP placement who also had penile curvature were divided into two treatment groups based on when the deformity was recognized: group A) when the penile deformity was known preoperatively, the patient underwent penile plication immediately prior to IPP insertion via the same penoscrotal incision; group B) patients whose penile curvature was recognized after inflation of the newly inserted IPP were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. A qualitative survey assessing penile curvature, adequacy for intercourse and overall patient satisfaction after surgery was administered. RESULTS Among 405 men receiving IPP at our institution from 2007-2014, 30 patients received synchronous reconstruction for penile curvature (7%). Group A included 23/30 (77%) patients, and 7/30 (23%) were in group B. Mean pre-op curvature overall was 37° corrected to <10°. A median of 4 sutures (range 3-6) were used for plication with each suture providing correction of approximately 8°. Average operative times were only 24 minutes longer compared to patients who underwent IPP placement only (88 vs 64 minutes, p<0.05). At an average 8 months of follow-up, 17/18 (94%) patients who completed surveys reported no residual curvature, erections adequate for sexual intercourse and an improved overall condition. One patient (7%) who underwent a complex biplanar plication reported minor residual curvature. No patient reported chronic pain or recurrent deformity. CONCLUSIONS Penile curvature can be safely and reliably reconstructed at the time of IPP placement in a definitive manner, regardless of whether or not the deformity was identified preoperatively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e969 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Tausch More articles by this author Paul Chung More articles by this author Jordan Siegel More articles by this author Alexandra Klein More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...