Abstract Introduction During the past 20 years, researchers have studied various aspects of the impact of prostate cancer therapies on patients, partners and couples. Patients and partners reported distress and negative consequences for their relationships resulting from treatment-related sexual side-effects of prostate cancer therapies. Research on rehabilitation strategies in prostate cancer survivorship has focused largely on biomedical interventions although psychosexual intervention research is also gaining ground. This research has never been summarized in such a way that clinicians can use the findings to provide evidence-based support for prostate cancer patients and their partners in survivorship. Objective An international panel of experts has developed a guideline that informs clinicians, patients and partners about the impact of prostate cancer therapies on the sexuality of patients and partners, and on their sexual relationships. It provides guidance for biopsychosocial rehabilitation strategies that help patients and partners recover sexual intimacy after prostate cancer therapy. Methods The guideline panel included international, multidisciplinary clinical experts and researchers in prostate cancer, a reference librarian and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995-2022). The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection is reported, based on PRISMA guidelines. Evidence for each statement was assigned a strength (A-C) and a level of recommendation (strong, moderate, conditional) which was based on benefit/risk balance. Data synthesis included meta-analyses of high-quality studies (determined by the Cochrane Risk of Bias tool). Results The guideline is contextualized within cultural, ethnic and racial diversity. The needs of individuals with diverse sexual orientations and gender identities are also recognized. Forty-seven statements were generated, guided by a theoretical model of sexual recovery after prostate cancer therapies and by principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. The statements focus on counseling about the impact of prostate cancer therapies on patients’ and partners’ sexuality and couples’ relationships as well as on biomedical and psychosocial treatment strategies for sexual dysfunction. The guideline statements address the assessment of sexual function and distress, and barriers to providing sexual health care in prostate cancer survivorship in globally varied health care systems. Conclusions The guideline documents the distressing sexual sequelae of prostate cancer therapies and makes evidence-based recommendations for sexual rehabilitation in prostate cancer survivorship. Areas for future research are also outlined. The guideline was supported and funded by the Movember Foundation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Author disclosures 1. Capogrosso 2. Northouse 3. Matthew 4. Elliott 5. Mulhall 6. Capellari 7. Incrocci 8. Faraday 9. Loeb 10. Mehta 11. Howell 12. McPhail J 13. McPhail S 14. Brandon 15. Paich 16. Erickson 17. Shifferd 18. Duby 19. Yap 20. Goltz 21. Odiyo 22. Salter 23. Nelson 24. McLeod 25. Trost 26. Wittmann – 10% salary paid by Movember 27. Bober – honorarium from UpToDate 28. Bennett - Endo Pharma - speaker 29. Coloplast - speaker, training grant. 30. Glode – Janssen, Aurora Oncology, Bayer, Exelixis, ProTechSure Scientific, Gonex, Patents, Seattle Genetics 31. Kirby – Lilly, Astra Zeneca, GSK, others 32. Wang – Boston Scientific, Teleflex, Coloplast 33. Pollack – Gilead 34. Burnett - Grant/research support: Endo Pharmaceutical, Boston Scientific, NIH Consultant/advisor: Boston Scientific, Coloplast, Reflexonic, Astellas, Novartis, Futura Medical, Comphya SA, Myriad Genetics Patent Holder: MHN Biotech Boards: UCF, AUA PAC, Mentoring Mae teens in the Hood Editor/editorial board: Urology Practice, Andrology, Canadian Journal of Urology, International Urology and Nephrology, Urology Times Other: UroMissionsWorks Inc (Non-profit) 35. Skolarus – UpToDate 36. Koontz - receives research funding from Janssen Scientific Affairs, Merck Pharmaceuticals, Blue Earth Diagnostics, and has received personal fees (ie advisory board) for Blue Earth Diagnostics.

Abstract Introduction As direct-to-consumer telemedicine (DTCT) companies increase virtual services for gender affirming medical therapy, examination of platform practices is essential to ensure the field’s standard of care is being met and cost-effective care is being offered. This is especially important considering the reduced access to care and potentially increased vulnerability of the gender-diverse population. Objective We aimed to describe the gender care services offered by DTCT companies for gender affirming medical therapy and to compare them to the current standards of care. We also compared the associated costs of each platform with those that may be encountered for similar care at a tertiary care center. Methods Google was queried in March 2022 to identify DTCT platforms offering gender affirming medical therapy. Platforms based outside the US were excluded. Websites were reviewed for information regarding the transgender affirming medical therapy and associated costs. Using a single institution’s online cost estimator, pay-per-service costs for similar care was estimated at a tertiary care center for a patient without insurance, with private insurance, and with Medicaid. The estimated costs for the first year of therapy with either oral estradiol or intramuscular testosterone were calculated and compared between each platform and the tertiary center. Services provided by DTCT platforms were also compared to those recommended by the World Professional Associated for Transgender Health (WPATH) Standards of Care, Version 7.1. Results Six transgender care DTCT platforms were identified: Folx, True U Clinic, QueerDoc, Queer Med, Trans Clinique, and Plume. All platforms offered gender affirming hormone therapy and several other gender care services (Table 1). All platforms utilized an Informed Consent Model for gender affirming therapy. None of the platforms offered mental or behavioral health services. Laboratory assessments for treatment monitoring were recommended at least quarterly upon treatment initiation, and typically reduced in frequency with ongoing care. Several platforms offered monthly membership payment plans ranging from $59 - $139/month and varying in service inclusion, while other platforms offered pay-per-service plans. The estimated first-year cost for initiation of hormone therapy via the DTCT platforms without insurance ranged from $1,022 to $1,428 for oral estradiol therapy and $1,184 to $1,668 for intramuscular testosterone therapy. In comparison, estimated first-year costs for estrogen and testosterone therapy at the tertiary center without insurance were $1,184 and $1,216, respectively (Figure 1). Estimated first-year costs were lower for a patient at the tertiary center with private insurance or Medicaid. Conclusions DTCT companies offer virtual care for gender affirming medical therapy for transgender, non-binary, and intersex people. Platforms utilized an Informed Consent Model and regular follow up with laboratory assessment, practices which appear to be consistent with the guidelines presented by WPATH. For patients without insurance, the first-year costs of gender affirming hormones are similar through DTCT platforms and a tertiary care center. There is a likely a cost benefit in receiving care through a tertiary center for patients with private insurance or Medicaid. DTCT companies can greatly expand access to transgender and gender affirming care. Disclosure No

Journal Article 305 Revision Surgeries as a Risk Factor for Postoperative Complications in IPP Placement Get access N. Bennett, Jr.,, MD, N. Bennett, Jr.,, MD Northwestern University School of Medicine Search for other works by this author on: Oxford Academic Google Scholar J. Miller J. Miller Northwestern University School of Medicine Search for other works by this author on: Oxford Academic Google Scholar The Journal of Sexual Medicine, Volume 17, Issue Supplement_1, January 2020, Page S73, https://doi.org/10.1016/j.jsxm.2019.11.202 Published: 01 January 2020

It is known that corpus spongiosum is an androgen-sensitive tissue and may be subject to atrophy in the presence of low serum testosterone (T) and an artificial urethral sphincter, leading to erosion. Similarly, low T causes structural alterations in cavernosal tissue, which may predispose to corporal fibrosis and subsequent difficult dilation, possible perforation and longer operative times during inflatable penile prosthesis (IPP) insertion. We sought to examine the correlation between pre-operative T and complications following IPP placement. Between 2000 and 2017, 65 consecutive patients (6 separate surgeons) with a pre-operative serum T level measured within 1 year of IPP surgery were identified. Revision surgeries were excluded. Low T was defined as <300 ng/dL. Patient characteristics including presence of diabetes mellitus, obesity, hypertension, cardiovascular disease, and history of prostate cancer were recorded. The primary outcome was rate of device infection or erosion. The secondary outcome was total operative time in minutes. Descriptive statistics using Wilcoxon rank sum and chi square testing were performed where appropriate.

Penile rehabilitation following radical prostatectomy is increasingly used to promote better recovery of post-prostatectomy erectile function. However, patient adherence to penile rehabilitation regimens is not optimal. Studies show that only 60-70% of men are compliant, with high medication cost often cited as a major contributing factor. The purpose of this study was to evaluate the medication costs associated with standard penile rehabilitation regimens at a tertiary academic medical center. Four high volume prostatectomists at our institution were surveyed regarding their preferred penile rehabilitation regimen as well as alternative regimens should the preferred regimen be ineffective or cost prohibitive. Prices for each component of the regimen were obtained using manufacturer pricing as listed on Epocrates as well as from pricing from our preferred compounding pharmacy. For cheaper oral alternatives, pricing was obtained from an offshore pharmacy. The total cost over two years was calculated for each regimen. Medical insurance coverage was not analyzed as it rarely covers the cost of sexual medicines.

To evaluate the efficacy and safety of testosterone replacement therapy (TRT) in patients with hypogonadal symptoms and low-normal to normal initial total testosterone (iTT). Institutional Review Board approval was obtained to retrospectively review men ≥ 18 years with hypogonadal symptoms without known cause and average iTT ≥ 225 ng/dL treated with TRT between January 2000 and August 2017. Exclusion criteria included TRT duration ≤ 1 month, clomid use concomitantly or within 6 months prior to TRT, prior prostate cancer (CaP), deep vein thrombosis/pulmonary embolism (DVT/PE), myocardial infarction (MI), polycythemia, or ischemic stroke. We collected data on demographics, comorbidities, medications, symptomatic changes, and adverse events (AE). Statistical analysis compared categorical and continuous variables and evaluated for predictors of improvement. 194 patients with TT ≥ 225 were treated with TRT. iTT was ≥ 300 in 33%. Mean age was 52.1 years [standard deviation (SD): 12.2]. Median length of TRT was 23.8 months [SD: 31.2]. The most common symptoms were erectile dysfunction (78.4%), low libido (75.8%), lethargy (60.3%), mood issues (15.0%), depression (11.3%), and muscle weakness (10.3%), which were comparable between those with TT of 225-299 (low-normal group) and TT ≥ 300 (normal group). Improvements in ≥ 1 symptom occurred in 73.1% of the low-normal TT group and 85.9% of the normal group (p = 0.0443). Significant factors associated with improvement of ≥ 1 symptom on univariate analysis were younger age and TT ≥ 300. On multivariate analysis (Table 1), TRT duration and younger age were independent predictors of reported improvement in ≥ 1 symptom; iTT was not. Major AE rates were comparable between both groups, and for the overall cohort were as follows: prostate biopsy 5%, CaP diagnosis 3%, polycythemia, 5%, DVT/PE 2%, ischemic stroke 0%, and MI 1.5%. One death occurred in the TT ≥ 300 group due to a gastrointestinal bleed secondary to anticoagulation.

Residual curvature after placement of a penile prosthesis (PP) is a common occurrence with many different opinions on how to “handle” the needed straightening and no objective, multicenter data. Moreover, there is no published data that shows how much each technique objectively improves the curvature intraoperative or compares these different corrective surgical methods. We present for the first time a large, prospective, multicenter study that evaluated intraoperative management techniques utilized, their efficacy and the need for adjunctive straightening methods intra-operatively. A total of 320 [of a total of 1348 (23.7%)] PP patients who underwent residual curvature correction techniques from the PROPPER database were included in this analysis. We evaluated 4 curvature correction techniques, up to 3 curvature corrections Made a commentused per patient. Wilson / Delk remodeling was the most common first curvature correction technique used (268/320) 84%: followed by tunical incision (23/320) 7.2%; incision and grafting (17/320) 5.3%; and plication (11/320) 3.4%. Nevertheless, the 2 most utilized first techniques were more likely to require additional correction techniques (p < 0.001) Whereas, the 2 least utilized Made a commentfirst techniques required the lowest need for a second curvature correction technique with incision and grafting needing no additional techniques and only one plication (1/11) 9% requiring an additional Wilson / Delk remodeling.

There is minimal data to evaluate the safety of closed suction drain use during penile prosthesis (PP) surgery. We sought to evaluate the safety of using drains during PP surgery from a prospective study. Data from the IRB-approved Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER), a large prospective dataset including data from 13 North American sites, was collected. The registry includes data on patient's baseline characteristics, erectile dysfunction (ED) etiology, surgical and peri-operative management strategies. Patients were stratified into two groups of “Drain” or “No Drain” used during PP surgery. Data from 1348 patients was analyzed with 634 (47%) patients with Drain and 714 (53%) patients with No Drain. The primary ED etiology, implant model and surgical dressing (compression/Mummy wrap) used were no different between the two groups (p>0.05). However, drains were used more commonly in infrapubic approaches, original (virgin) surgeries, when significant corporal fibrosis was noted, with concurrent procedures and curvature correction procedures. Operative time was greater with drain placement (57.8 vs 43.7 min, p=0.001). There was no difference in abscess formation, adhesion of pump, cellulitis, device infection, penile edema, pump migration, pain/discomfort, superficial wound infection or wound dehiscence between both groups (p> 0.05). Ironically, there were 4 scrotal hematomas in the Drain group and none in the No Drain group (p= 0.034). In these 4 patients, the operative time was longer than average (64 min vs 57.8 vs 43.7 min, p= 0.005). All were virgin implants, 2 after RRP, 1 with diabetes and 1 other. Only one patient had a concurrent procedure (circumcision), 2 were done with an infrapubic approach and 2 were penoscrotal approach. All 4 patients were managed conservatively and only one patient is using his devices at 2 year follow-up.

There is a paucity of information available on the use of and satisfaction with penile prosthetics in patients with Peyronies disease who also have erectile dysfunction. The Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER) registry was analyzed for use and satisfaction at 1 and 2 years post-implant, comparing patients given a primary diagnosis of Peyronies disease (PD) as a cause of their erectile dysfunction (ED) to patients with a different etiology of ED. Patients with a secondary diagnosis of PD with a different primary cause of the ED were not considered in this particular analysis. 1018 men had data available at 1 year followup, and 826 men had data at 2 years. Only 1 patient in the non-PD group (n= 923) had missing data at 1 year, 2 patients at 2 years, and no patients in the PD group (n=95) had missing data. When stratified into “very satisfied/satisfied” versus other categories, 86.3% of PD patients were satisfied at 1 year versus 85.8% of non-PD patients (p=0.912). 78.9% of men in the PD group were using the device at least once per month (mean 6.3±5.0 vs mean 6.3±5.7). At 2 years, satisfaction remained consistent. Using the same stratification, 85.9% were very satisfied or satisfied, versus 85.2% in the non-PD patients. In the PD group, 75.3% of patients used the device at least once a month (mean 6.1±4.8), compared to 74.9% of men in the non-PD group (mean 6.2±5.2).

The “Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration” (PROPPER) is a large, multi-institutional, prospective clinical study, whose main function is to prospectively collect, analyze, and report real-world outcomes for men implanted with penile prosthetic devices. The objective of this analysis was to determine the incidence of penile curvature that was not appreciated prior to placement of an inflatable penile implant (IPP). Data from the PROPPER study was examined to determine the incidence of previously unrecognized curvature requiring adjunct treatment at the time of IPP. This was defined as any curvature on artificial/pharmacologic erection >0 degrees. Through 5/23/2016, 1268 men underwent implantation of penile prosthesis at a total of 11 study sites. Of those, 255 were given a primary or secondary diagnosis of peyronies disease (PD). Within the remaining 1013 men, 116 (12%) were determined to have curvature >0 degrees, with initial intraoperative curvature of 29.8 ± 13.5 degrees. After an initial curvature correction procedure, the 2nd measurement was 12.9 ± 10.4 degrees, with 40 patients going on to a 2nd type of correction technique. Nine patients required a third technique, with final curvatures reported as 9.4 ± 6.8 degrees.

Assess efficacy, safety, and overall satisfaction of AMS 700 penile prosthesis (PP) placement in men with Peyronie's disease (PD) versus non−Peyronie’s disease (NPD) using the Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER). PD is a difficult condition to treat and has had a history of lower patient satisfaction rates in the literature after PP than NPD patients. The PROPPER registry prospectively evaluates outcomes in men undergoing penile prosthesis. Data was collected at baseline and annually out to 5 years. The goal of this analysis was to compare PD patients (n=259) to NPD patients (n=998). 1257 men underwent insertion of AMS 700 at 11 North American sites as of Sep 13, 2016. This is an ongoing study; one and two year data is available on 855 (68.0%) and 619 (49.2%) patients, respectively. When operative times were reported there was a significant difference between PD and NPD patients (52±34 min vs 45±27 min (p=0.001)). PD patients (45.2%) were more likely to receive a CX cylinder compared to NPD patients (35.7%), while NPD patients (53.9%) were more likely to receive a LGX cylinder compared to PD patients (43.6%), p-value: 0.008. There was no significant difference in depression rates between the two groups at baseline, 1 and 2 years follow-up. Overall, 84.1% and 85.1% of patients were satisfied or very satisfied at 1 and 2 year follow-up respectively, with no significant differences in patient satisfaction scores between PD and NPD patients.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy I1 Apr 2015PD26-02 A REVIEW OF MICROORGANISMS ISOLATED AT SALVAGE OR EXPLANT OF IPPS: ARE WE COVERING THE CORRECT BUGS? Martin Gross, Francois Eid, Christopher Yang, Ross Simon, Daniel Martinez, Rafael Carrion, Paul Perito, Nelson Bennett, Laurence Levine, Jason Greenfield, and Ricardo Munarriz Martin GrossMartin Gross More articles by this author , Francois EidFrancois Eid More articles by this author , Christopher YangChristopher Yang More articles by this author , Ross SimonRoss Simon More articles by this author , Daniel MartinezDaniel Martinez More articles by this author , Rafael CarrionRafael Carrion More articles by this author , Paul PeritoPaul Perito More articles by this author , Nelson BennettNelson Bennett More articles by this author , Laurence LevineLaurence Levine More articles by this author , Jason GreenfieldJason Greenfield More articles by this author , and Ricardo MunarrizRicardo Munarriz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current AUA guidelines regarding IPP implantation dictate that the standard of care is to use antibiotics that cover Gram-positive and Gram-negative organisms. Surgical prophylaxis with aminoglycosides, vancomycin, cephalosporins, and fluoroquinolones is recommended. These guidelines are intended to prevent infection with skin flora (the most likely cause of infection per the literature) and urinary tract flora. A review of organisms cultured during IPP salvage or explant at our institutions indicates that fungi and anaerobes are prevalent isolates. These organisms are not covered by the recommended antibiotic regimens. METHODS This is a retrospective multi-institution study of 65 patients with IPPs who presented with infections. These patients underwent either prosthesis explant or Mulcahy salvage procedure with device replacement. Patients' operative notes and charts were extensively reviewed to compile study data. Antibiotics were recorded at implantation, immediately prior to infection-related surgery, and during infection-related surgery. RESULTS Between 2002 and 2014 65 patients presented with IPP infection. Antibiotic regimens for all patients at implantation were consistent with current AUA guidelines. Intraoperative cultures were obtained at the time of either salvage or explant. 42 patients had at least one organism cultured from their wound at time of salvage or explant. 5 had more than one organism. Coagulase negative staph was the most commonly cultured organism, and was present in 20 isolates (31%). Candida albicans was the second most commonly cultured organism, and was present in 8 isolates (12%). Other cultured organisms included expected Gram-positive and Gram-negative flora: MRSA (5 patients, 8% of all cultures), group B strep (5, 8%), prevotella bivia (2, 3%), enterococcus (2, 3%), pseudomonas (2, 3%), staph epidermidis (1, 1.5%), and klebsiella (1, 1.5%). Anaerobes, including peptostreptococcus, clostridium innocuum, bacteroides tectus, and lactobacillus acidophilus, were individually cultured once, occurring at a rate of 1.5% each. CONCLUSIONS Intraoperative cultures obtained from infected IPPs in this sample show an unexpected rate of microorganisms that are not covered by current AUA recommended antibiotic regimens. Candida was present in 12% of cultures, and anaerobes were present in four total cultures, for a combined prevalence of 6%. Further correlation with data from other providers may verify if this trend indicates a need to broaden antifungal and antibiotic coverage at implantation, salvage, or explant. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e566 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Gross More articles by this author Francois Eid More articles by this author Christopher Yang More articles by this author Ross Simon More articles by this author Daniel Martinez More articles by this author Rafael Carrion More articles by this author Paul Perito More articles by this author Nelson Bennett More articles by this author Laurence Levine More articles by this author Jason Greenfield More articles by this author Ricardo Munarriz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Heretofore, the published data on penile implant patients consisted generally of small series of single-surgeon, retrospective experiences rather than prospective or large, multicenter evaluations. This study establishes a baseline of data collection from PROPPER (Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration). PROPPER is the first large, prospective, multicenter, multinational, monitored, and internal review board (IRB) -approved study of real-world outcomes for penile implant patients. Data from the PROPPER study was examined to determine patient baseline characteristics and primary and secondary etiologies prior to ED treatment, to include: type and size of implant received; surgical steps/techniques utilized during implantation; and duration of hospital stay. Through June 22, 2015, a total of 1077 patients were enrolled in the study at 11 sites, with: 1039 patients implanted with AMS 700, 27 patients implanted with Ambicor, and 11 patients implanted with Spectra. Radical prostatectomy (RP) was the predominant etiology in 307 (28.5%) subjects. The other major contributing etiologies included: 230 subjects with diabetes (21.4%), 219 subjects with cardiovascular disease (20.3%), and 97 subjects with Peyronie’s disease (9%). Of those 307 RP patients, 301 (98%) received an AMS 700. Of these patients, 66.4% (200/301) had placement of the reservoir in the traditional retropubic space, versus 29.2% (88/301) in a submuscular location. Compared to those non-RP patients receiving an AMS 700, less patients underwent reservoir placement in the submuscular location 17.1% (126/737), versus 81.3% (599/737), p-value:<0.001. Moreover, length of procedure for RP patients 50 + 28.1 compared to non-RP patients 47.0 + 30.5 minutes was not significant p = 0.192. AMS700 patient status in terms of hospital length of stay revealed that 531 patients (51.2%) remained under 24 hour observation, while 457 (44%) underwent same-day surgery discharge with 50 (4.8%) admitted for more than 24 hours.

Until now, the published data on penile implant patients consisted generally of small series of single-surgeon, retrospective experiences rather than prospective or large, multicenter evaluations. This study establishes a baseline of data collection from PROPPER (Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration). PROPPER is the first large, prospective, multicenter, multinational, monitored, and internal review board (IRB)-approved study of actual outcomes for penile implant patients. We examined data from the PROPPER study to determine patient baseline characteristics and primary and secondary etiologies before ED treatment, including: type and size of implant received; surgical steps/techniques utilized during implantation; and duration of hospital stay. Through September 1st, 2015, a total of 1122 patients were enrolled and implanted in the study at 11 sites, with: 1084 patients implanted with AMS 700, 27 patients implanted with Ambicor, and 11 patients implanted with Spectra. Radical prostatectomy (RP) was the chief etiology in 313 (27.9%) subjects. The other primary contributing etiologies included: 239 subjects with diabetes (21.3%), 223 subjects with cardiovascular disease (19.9%), and 99 subjects with Peyronie’s disease (8.8%). Of those 313 RP patients, 307 (98.1%) received an AMS 700. Of these patients, 66.4% (204/307) had placement of the reservoir in the traditional retropubic space, versus 29.3% (90/307) in a submuscular location. Compared to those non-RP patients receiving an AMS 700, less patients underwent reservoir placement in the submuscular location 16.6% (129/777), versus 81.9% (636/777), p-value:<0.001. Also, length of procedure for RP patients 49.9 ± 28.1 compared to non-RP patients 46.7 ± 30.3minutes was not significant p = 0.171.

Plaque incision/excision and grafting are a specialized procedure reserved for men with Peyronie’s disease, featuring severe penile curvature, near-normal erectile function, and adequate erectile length. The choice of graft material requires careful consideration of the positive and negative attributes. Grafts may be divided into three distinct categories: synthetic, autologous, and extracellular materials. A description of each is presented below with a brief relevant literature review.

Peyronie's disease (PD) is a progressive wound-healing disorder highlighted by an inelastic fibrous scar in the tunica albuginea. Its etiology has been linked to a history of penile trauma and subsequent microvascular insults followed by extravascular activation of the fibrotic cascade. The most common clinical manifestation is a dorsal curvature and an associated palpable plaque. Subjective symptoms include painful erections, sexual dysfunction, and significant psychosocial burden. Options for non-surgical management of PD include penile stretching programs and devices, oral medications, and injectable agents (interferon-alpha 2B, verapamil). No single agent or modality has been shown to reliably alter fibrotic disease process resulting in modest and inconsistent benefits in a minority of men. Collagenase clostridium histolyticum (CCh) intralesional injection is Food and Drug Administration approved for adult men with PD with a palpable plaque and non-ventral curvature of at least 30 degrees at the start of therapy. CCh is a bacterially derived collagenase that cleaves the collagen triple-helix within the Peyronie's plaque potentially leading to change in plaque and penile morphology. Each CCh injection cycle consists of two Peyronie's plaque injections followed by an in-office penile modeling session. The patient may require up to four cycles of CCh to achieve maximal penile straightening.