BACKGROUND:Prostate cancer remains one of the most common cancers in men, and while active surveillance using serial prostate-specific antigen (PSA), imaging, and biopsies is the preferred management for low-risk cases, concerns remain about the impact of biopsy-related sexual dysfunction due to proximity to neurovascular bundles. AIM:To evaluate the association in biopsy frequency and sexual function in men on active surveillance (AS) for low-grade prostate cancer. METHODS:We analyzed data from the Miami Active Surveillance Trial (MAST, a prospective, single-arm study of men with Gleason grade ≤2 prostate cancer under AS, managed with annual magnetic resonance imaging-ultrasound fusion-guided transrectal ultrasound (TRUS) biopsies. Sexual and hormonal function was assessed using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire at baseline and 12-, 24-, and 36-month follow-ups. Minimally important differences (MID) were defined as 10-12 points for the sexual domain, and 4-6 points for the hormonal domain. Statistical analysis involved repeated measures analysis of variance (ANOVA) and paired t-tests using distribution of EPIC scores. OUTCOMES:Annual transrectal biopsies were associated with small, statistically, but not clinically significant declines in sexual function, with no meaningful impact on overall quality of life observed. RESULTS:Among 200 men enrolled, the median age was 62 years old, 89.5% were white, and 43% were Hispanic. A total of 52 men completed all follow-up biopsies. The mean baseline sexual function score was 43.7 (SD 13.1). Repeated measures ANOVA indicated a statistically significant decline in sexual function over time (P = .0105). Though statistically significant, this decline did not exceed the MID threshold for the sexual domain and therefore not clinically significant. Hormonal scores remained stable and showed no significant difference across time points (P = .5767). CLINICAL IMPLICATIONS:These findings support annual biopsy usage in AS protocols for clinicians without compromising sexual function. STRENGTHS & LIMITATIONS:The strengths of this study include rigorous annual biopsy protocols and validated EPIC measures to identify clear clinically significant thresholds. Limitations include sample attrition over time due to longer follow-up and single-institution design. CONCLUSION:Increased frequency of TRUS biopsies was associated with a statistically, but not clinically significant decline in sexual function, indicating that annual TRUS fusion biopsies are not likely to significantly impact sexual health and may be confidently recommended for patients on active surveillance.

BACKGROUND:Peyronie's disease (PD) is an acquired connective tissue disorder characterized by fibrous plaque formation within the penile tunica albuginea that may be influenced by androgen status. AIM:To evaluate whether baseline testosterone levels and testosterone therapy (TTh) during collagenase clostridium histolyticum (CCH) treatment affect curvature severity and treatment outcomes in men with PD. METHODS:This multi-center retrospective study included men with PD treated with CCH who had no curvature progression in the preceding three months and documented baseline testosterone levels. Demographics, baseline and post-treatment curvature, pain, plaque calcification, adverse events, TTh use, and surgical conversion were analyzed. Testosterone deficiency was defined as testosterone <300 ng/dL and concurrent signs or symptoms of low testosterone. Multivariable analyzes assessed predictors of curvature improvement. OUTCOMES:Primary outcomes included change in penile curvature following CCH therapy and secondary outcomes included adverse events and surgical conversion rates. RESULTS:Among 790 men, 778 met inclusion criteria (mean age 56.6 ± 9.1 years), with a median of eight CCH injections. Testosterone deficiency was present in 21% (n = 166), of whom 54% (n = 90) received TTh. Baseline curvature was similar among eugonadal men, testosterone deficient men on TTh, and testosterone deficient men not receiving therapy (45° vs. 44° vs. 48°, P = .392), as were pain symptoms and disease duration, though plaque calcification was more common in testosterone deficient men (P = .039). Mean curvature improvement was greatest in eugonadal men (24°), followed by testosterone deficient men on TTh (19°) and testosterone deficient men without therapy (17°). On multivariable analysis adjusting for age, baseline erectile dysfunction, baseline curvature severity, plaque calcification and post procedure modeling, both testosterone deficient groups remained independently associated with less curvature improvement compared with eugonadal men, with no significant difference between testosterone deficient men receiving versus not receiving TTh. Testosterone deficient men experienced higher rates of pain requiring medication (P < .05). Other adverse events and surgical conversion rates were similar across groups. CLINICAL IMPLICATIONS:Baseline androgen status may influence response to CCH therapy and should be considered during counseling and treatment planning. STRENGTHS AND LIMITATIONS:Strengths include a large multi-center cohort and multivariable analysis, while limitations include retrospective design, variability in TTh regimens, and potential unmeasured confounders. CONCLUSION:Testosterone deficiency is associated with reduced curvature improvement following CCH therapy regardless of testosterone treatment, with eugonadal men demonstrating the greatest therapeutic benefit.

BACKGROUND:Many patients do not follow up for repeat semen analysis after potential vasectomy failure, indicating a need for strategies to enhance compliance and maximize outcomes. OBJECTIVE:To evaluate the rate of men who do not return for repeat semen analysis after suspected or confirmed vasectomy failure, defined as presence of motile or >100,000 non-motile sperm on post-vasectomy semen analysis, and investigate subsequent management. MATERIALS AND METHODS:We conducted a retrospective chart review of males aged ≥18 years old who underwent vasectomy for the first time between January 2004 and January 2024. We examined adherence to and timing of follow-up semen analyses and subsequent vasectomy outcomes, rates of non-compliance with follow-up, management strategies. RESULTS:Of 2567 patients, 42.1% did not follow up at any time point post-vasectomy. Of those with spermatozoa on initial semen analysis < 3 months post-vasectomy, 43.3% failed to return for repeat testing. Nearly, 47% percent of those with spermatozoa present on first post-vasectomy semen analysis at or after 3 months also failed to follow up to re-evaluate sterility. Management of patients who did follow up often included repeat semen analyses at 6-week intervals until a negative result was produced or repeat vasectomy. CONCLUSION:Alarmingly, many patients who could not be cleared to resume sexual activity after vasectomy did not follow up for repeat semen analyses. This highlights a significant deficit in compliance, which may benefit from interventions such as improved counseling and reminder systems. Future research should explore the impact of these interventions on compliance rates and explore rates of unintended pregnancy associated with loss to follow up.

Purpose: During vasectomy, technical errors such as difficulty identifying and transecting the vas deferens may occur. Pathology reports indicating an incompletely transected vas may create uncertainty regarding procedural success. However, there is a paucity of large cohort studies investigating this correlation. To address this gap, we explored the relationship between abnormal pathology reports and vasectomy failure rates to determine whether such reports should impact clinical decision making. Methods: We retrospectively reviewed charts of men aged ≥18 who underwent vasectomy between 2004–2024. Abnormal pathology reports failed to identify complete vas deferens cross sections. Vasectomy failure was defined as presence of motile sperm or ≥100,000 nonmotile sperm on postvasectomy semen analysis (PVSA) ≥3 months. Results: Of 2446 vasectomies with pathology reports, 2399 (98.1%) reports were normal, 1330 returned for PVSA, and 55 were failures (4.1%). Conversely, 47 (1.9%) had an abnormal report. Of these, 31 patients returned for PVSA, 87.1% ( n = 27) were successes with failure rate of 9.7% ( n = 3), and one patient had sperm on PVSA <3 months after vasectomy but was lost to follow‐up. The three failures were secondary to errors in transecting the vas on one side. Pathology reports stated “benign nerve and fibrovascular tissue,” “artery,” and “no vas deferens lumen visualized.” Conclusions: Outcomes from a large cohort over two decades suggests although pathology provides early feedback, abnormal reports do not reliably predict vasectomy failure. Pathology should not independently guide clinical decision making without confirmatory semen analysis, which remains the marker of success. Future research could investigate outcomes of patients with abnormal pathology who did not follow up for semen analysis.

Introduction Vasectomy is a common procedure for male sterilization. During pre-procedural counseling, men and their partners are often concerned with postoperative pain or sexual dysfunction. Research examining internet forums to explore these concerns is limited. In this study, we selected Reddit, a popular and anonymous online platform for user discussion, to qualitatively investigate patient experiences and questions surrounding vasectomy so healthcare providers may better understand patient concerns. Methods Threads, composed of a primary post to the website and associated comments, are organized into topic-focused forums known as subreddits. We collected threads from the Reddit group "Vasectomy" over a 12-month period. Terms searched included "pain," "volume," "erect," and "ED." Threads not focused on these terms were excluded. Two investigators trained in qualitative research used a modified grounded theory to independently code threads using key phrases. Similar phrases were grouped to form themes, which were refined into concepts. Results Threads discussed pain, ejaculate volume, and erectile dysfunction (ED) after vasectomy. An analysis of 87 threads with 1,052 responses revealed three themes: men on Reddit seek validation, recount their vasectomy experiences, and share anxieties. Concepts suggest men utilize the community to cope with these anxieties and that a discrepancy exists between expectations set by physicians and patients' actual postoperative experiences. Conclusions This study provides valuable clues about patients' perspectives on vasectomy and the information they seek or share online. Discrepancies exist between patient expectations and guidance provided by urologists, suggesting a need for more tailored preoperative counseling. By actively acknowledging concerns about vasectomy, healthcare providers may potentially be able to better understand and cater to patient needs.

Abstract Introduction Estimates of total vasectomies performed in the United States each year range between 500-600,000. While all available data indicates vasectomies are safe, men and their partners are often concerned about post-operative pain or sexual dysfunction, such as changes in ejaculation characteristics or erectile dysfunction (ED). Research examining internet discussion groups to better understand men’s concerns and experiences with the procedure is limited. Examining online forums to see patients' information needs regarding vasectomy will allow physicians to provide evidence-based guidance, rather than anecdotal sources that people often rely on. Given recent restrictions of women’s reproductive rights, public interest in vasectomy as a form of contraception has risen significantly. With approximately 52 million daily active users, Reddit is a popular platform for user discussion, especially among people of reproductive age. In this study, Reddit was selected as a vehicle to qualitatively investigate patient experiences, emotions, and questions surrounding vasectomy. Objective This research aims to explore men's experiences and expectations regarding pain and sexual dysfunction after vasectomy, as posted on an anonymous internet forum, in order to enhance communication between healthcare providers and patients for an improved overall patient experience. Methods Threads on the Reddit group “r/Vasectomy”, with 15,000 members, were collected over a 12-month period. We searched the terms “pain”, “volume”, “erect”, and “ED”. Any thread where the primary post was not focused on these terms were excluded. Two investigators, with training in qualitative research, read and independently coded relevant threads based on a modified grounded theory. Each line of a thread was coded using key phrases and the grouping of similarly coded phrases led to the emergence of themes, which were later refined into general concepts. Results Analysis of 87 distinct threads with 1052 responses revealed that men utilized the online platform to cope with pre-operative anxieties, seek validation, and share experiences. These themes reinforced the concept that men utilize community to cope with their anxieties surrounding vasectomy. Discussions revolved around concerns regarding pain, ejaculate volume, and erectile function. Additionally, there was a noticeable information discrepancy between expectations set by healthcare professionals and the actual post-operative experiences shared by patients. Conclusions This study provides valuable insights into patients' perspectives on vasectomy and the information that they seek from online forums after their visit with a physician. Discrepancies exist between patient expectations and medical guidance provided by urologists, suggesting a need for more tailored and comprehensive pre-operative counseling. By understanding these concerns, healthcare providers can enhance patient education and outcomes related to vasectomy procedures. Disclosure No.

Abstract Introduction Erectile dysfunction (ED) has long been associated with cardiovascular disease, a sedentary lifestyle, smoking, obesity, and diabetes. However, the role of environmental factors in ED is still not fully understood. Current literature is unclear on the relationship between heavy metal exposure and ED, despite growing evidence that such exposure can lead to oxidative stress, thereby increasing the risk of various diseases. The All of Us (AoU) Research Program is a prospective clinico-genomic database that focuses on individuals from underrepresented populations. Objective We aimed to use the AoU database to examine how high levels of heavy metals in the blood relate to erectile dysfunction. Methods AoU release version 7 was analyzed. Men with an EHR-coded diagnosis of ED were included in the analysis. Serum and blood levels of lead, selenium, magnesium, zinc, and copper were analyzed. Patients with elevated heavy metal levels in the blood were defined as those with lead levels above 25 μg/dL, selenium levels above 160 μg/L or 0.1 ppm, magnesium levels above 2.2 mg/dL, zinc levels above 120 μg/dL, and copper levels above 140 μg/dL or ceruloplasmin levels above 40 mg/dL. P-values were calculated using univariate logistic regression and chi-squared tests with Bonferroni correction. Results The total cohort of men was 153 582, with 15 523 of them having ED (10.1%). Of these men, 19.2% were Black, 62.9% were White, and 17.9% were of another race. Among men with ED, 66.1% were over 65 years old, 26.8% were 45-64 years old, and 4.4% were 18-44 years old. Patients with elevated lead (OR: 4.58, p < 0.001), zinc (OR: 2.07, p = 0.005), or magnesium (OR: 1.39, p < 0.001) levels were more likely to have ED. However, elevated copper (OR: 0.67, p = 0.005) and selenium (OR: 0.955, p = 0.874) levels were not associated with a higher rate of ED. Overall, men with ED who had elevated heavy metal levels were more likely to have a higher BMI (p = 0.010), be unemployed (p < 0.001), have low income (p < 0.001), rent their homes (p < 0.001), and be older (p < 0.001). There was no significant difference in education status (p = 0.172) or race (p = 0.117). Conclusions Using a large prospective database that focuses on underserved populations, our study found that heavy metal levels higher than established cutoffs were associated with higher rates of ED. Lead appeared to have the largest effect on ED rates, while zinc surprisingly had a higher odds ratio of being elevated in patients with ED. These results add to the relatively scant literature on heavy metals' influence on ED. Lastly, our findings suggest that it is important to include heavy metals in the risk assessment for ED. Disclosure No.

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (PD52)1 May 2024PD52-01 A PHASE 2 RANDOMIZED, PLACEBO-CONTROLLED CROSSOVER TRIAL TO EVALUATE SAFETY AND EFFICACY OF PLATELET-RICH PLASMA INJECTIONS FOR PEYRONIE'S DISEASE: CLINICAL TRIAL UPDATE David A. Velasquez, Braian R. Ledesma, Manuel Molina, Francesco Costantini-Mesquita, Christabel Egemba, Emad Ibrahim, Thomas Masterson, Nicholas A. Deebel, Sunwoo Han, Isildinha M. Reis, Russell Saltzman, and Ranjith Ramasamy David A. VelasquezDavid A. Velasquez , Braian R. LedesmaBraian R. Ledesma , Manuel MolinaManuel Molina , Francesco Costantini-MesquitaFrancesco Costantini-Mesquita , Christabel EgembaChristabel Egemba , Emad IbrahimEmad Ibrahim , Thomas MastersonThomas Masterson , Nicholas A. DeebelNicholas A. Deebel , Sunwoo HanSunwoo Han , Isildinha M. ReisIsildinha M. Reis , Russell SaltzmanRussell Saltzman , and Ranjith RamasamyRanjith Ramasamy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009412.04863.1b.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie's Disease (PD) is a condition characterized by localized inflammation leading to the formation of fibrotic plaques within the penile tunica albuginea, resulting in penile curvature and painful erections. Existing therapeutic options are limited. Platelet-Rich Plasma (PRP) may be a promising alternative due to its potential to modulate inflammatory processes. However, few placebo-controlled clinical trials exploring PRP's impact for PD exist. This study investigates the safety and efficacy of PRP injections in PD. METHODS: We present an ongoing randomized, placebo-controlled, crossover study conducted at the University of Miami, aiming to evaluate the safety and potential benefits of intralesional PRP injections for PD. We have enrolled 52 subjects into two groups, PRP-placebo sequence (Group A) and placebo-PRP sequence (Group B). Each group receives two injections of PRP and two placebo injections (saline) over six months, with crossover at the midpoint. Immediate and follow-up assessments, including pain scale measurements, goniometer assessments, questionnaires, and curvature evaluations, were conducted at baseline, three months, and six months. RESULTS: Interim analysis of 28 subjects who have completed the study shows PRP's safety and potential efficacy. No minor or major adverse events, such as penile bruising, swelling, edema, allergy, or penile fracture were reported. We also observed a 25% reduction in curvature (median of 10-degree reduction, p=0.047) in Group A after six months compared to baseline. CONCLUSIONS: Preliminary data show that PRP injections as safe and potentially effective for PD. These findings, although from a limited sample with complete data, are noteworthy for the absence of adverse events. Current research with extended follow-up aims to clarify the long-term therapeutic role of PRP in PD. Download PPT Source of Funding: Supported by NIDDK grants R01 DK130991, UE5 DK137308, and Clinician Scientist Development Grant from American Cancer Society to RR © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1072 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information David A. Velasquez More articles by this author Braian R. Ledesma More articles by this author Manuel Molina More articles by this author Francesco Costantini-Mesquita More articles by this author Christabel Egemba More articles by this author Emad Ibrahim More articles by this author Thomas Masterson More articles by this author Nicholas A. Deebel More articles by this author Sunwoo Han More articles by this author Isildinha M. Reis More articles by this author Russell Saltzman More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Eosinophilic cystitis (EC) is a rare inflammatory condition characterized by eosinophilic infiltration into the bladder wall. It often presents symptoms common to urological issues such as urinary tract infections, hematuria, bladder stones, or bladder neoplasms. Here, we describe a case of a 44-year-old male veteran with a history of multiple tuberculosis episodes who presented to the Emergency Department with dysuria, suprapubic pain, and gross hematuria.Initial imaging and cystoscopy concerned bladder neoplasia; however, subsequent pathological evaluation showed EC. This case underscores the importance of considering EC in the differential diagnosis of bladder tumors, especially when imaging describes bladder wall thickening in a patient without risk factors for bladder malignancy.

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-09 THE IMPACT OF VIRTUAL REALITY(VR) ON PATIENT EXPERIENCE UNDERGOING PROSTATE BIOPSY Paulo R. Marcelo Moscardi, Ruben Blachman Braun, Nicholas Ruiz, and Thomas A. Masterson Paulo R. Marcelo MoscardiPaulo R. Marcelo Moscardi , Ruben Blachman BraunRuben Blachman Braun , Nicholas RuizNicholas Ruiz , and Thomas A. MastersonThomas A. Masterson View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate biopsy stands as prevalent ambulatory urological procedure frequently associated with significant patient anxiety and discomfort. These factors pose potential obstacles, particularly in cases of repeated biopsies. This challenge is exacerbated in patients with increased rates of anxiety and PTSD, such as veterans. To address these concerns, VR emerge as a non-pharmacological approach employed as a peri-operative adjunct to enhance anxiolysis and analgesia. This study aims to analyze the use of VR to alleviate anxiety, reduce pain, and enhance overall experience for patients undergoing prostate biopsy. METHODS: Between Aug-Sep/23, we recruited patients from VA institution undergoing prostate biopsy. Along the procedure, a VR headset was utilized (model Pico Neo3–Waya Health). During the procedure the patient had 4 options to cycle through including Procedural Dome, 360 Panoramic Views, Memory Game, and 360 Scuba Dive. Each patient is given a quick tutorial on how to use the headsets. Prior to and following the procedure, patients completed the Defense and Veteran Pain Rating Scale (DVPRS) and the Stress and Trait Anxiety Inventory Scale 5 (STAIS-5). Moreover, we collected and analyzed clinical data both before and after the procedure, encompassing variables such as heart rate, respiratory rate, SBP/DBP etc. RESULTS: We identified 20 patients that consented for the study. The mean age was 64.4±7.6 years. The average procedure duration was 15.3±4.4 min, not significantly different from the perceived time reported by the patients (14.8±5 mins, p=0.320). There were no notable differences observed in clinical data or the recorded scores (DVPRS and STAIS-5) before and after the procedures as displayed in Table 1. Of particular interest, a significant proportion of patients (90% strongly agreed or agreed) reported experiencing reduced anxiety during the procedure, while 75% reported a decrease in perceived pain (Table 2). CONCLUSIONS: Utilizing VR during invasive urological procedures, such as prostate biopsy, has shown a substantial potential to notably reduce both anxiety and perceived pain. This reduction can significantly enhance the patient experience, potentially streamlining the process for recommending such interventions and leading the way for improved experiences in future procedures. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e464 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Paulo R. Marcelo Moscardi More articles by this author Ruben Blachman Braun More articles by this author Nicholas Ruiz More articles by this author Thomas A. Masterson More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction Peyronie's disease (PD) is an acquired connective tissue disorder characterized by the formation of fibrous plaques within the tunica albuginea of the penis. There has been speculation suggesting that hypogonadism and testosterone levels prior to treatment with Collagenase Clostridium Histolyticum (CCH) impacts the degree of initial curvature in patients with PD, as well as the improvement of penile curvature following CCH management. This may be due to the role testosterone plays in collagen metabolism and wound healing. However, smaller, single institution studies have not found a significant correlation between baseline testosterone level and PD. Objective This study aimed to determine whether baseline testosterone levels prior to CCH treatment impacted penile curvature on presentation, improvement in curvature, and any side effects experienced by patients with PD. Methods This multi-center, retrospective study was approved by our Institutional Review Board and investigated patients who received CCH injections for the treatment of PD. Inclusion criteria consisted of patients who received CCH treatment without worsening curvature and for whom we recorded pretreatment baseline testosterone levels. Demographic data were extracted from patients' medical records as well as pre-treatment and post-treatment penile curvature, overall change in curvature, and hypogonadal status. Hypogonadism was defined as a baseline testosterone level < 300 ng/dl. Results In total, 176 patients met inclusion criteria. The average age of the cohort was 57 years (SD 9.14) and the mean total baseline testosterone was 499.8 ng/dl (SD 305.6). The average pre-treatment penile curvature was 48.3° (SD 15.5), while average post-treatment penile curvature was 32.7° (SD 16.5). Overall, the mean improvement in curvature was found to be 15.6°. In those with hypogonadism, average pre-treatment penile curvature was 48.5° (SD 13.8), compared to 48.3° (SD 15.9) in those without hypogonadism. This was not statistically different (p = 0.4737). Average improvement of penile curvature in those with hypogonadism was 16.1° (SD 12.5) and 15.5° (SD 12.7) in those without hypogonadism, which was not found to be statistically different (p = 0.8237). On linear regression analysis, pre-treatment testosterone levels did not significantly predict improvement in the degree of penile curvature patients may experience (β = 0.002; R2 = 0.002; p = 0.5271). Table 1 summarizes average baseline testosterone levels in those experiencing side effects with CCH treatment, or patients who opt for surgical management of their PD; this relationship was not statistically significant. Conclusions Baseline testosterone levels prior to CCH treatment are not associated with pre-treatment penile curvature, improvement in penile curvature, or side effects experienced amongst PD patients. Disclosure No.

Xiaflex® (collagenase clostridium histolyticum) is a Food and Drug Administration-approved treatment for patients with Peyronie's disease. Despite its approval and implementation, there is concern that urologists in training are offered minimal exposure to its use. Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie's disease and its management, particularly Xiaflex®. A Google Forms survey regarding the exposure of residents to Peyronie's disease and use of Xiaflex® was created and disseminated through email to urology programs. Overall, 47 institutional responses were received. At 45 institutions (95.7%), residents receive training in directly evaluating and caring for patients with Peyronie's disease. At 46 institutions (97.9%), residents receive training in observing and/or performing surgical procedures for Peyronie's disease. Residents at 31 institutions (66.0%) receive observational or procedural training for non-surgical management of Peyronie's disease, specifically Xiaflex®. Residents receive non-surgical training from an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty not trained in sexual medicine at six institutions. There exists a glaring disparity in residency exposure to Xiaflex®. Further research is warranted to elucidate how programs can provide residents with further exposure to the use of Xiaflex® in patients with Peyronie's disease.

Insertion of inflatable penile prosthesis (IPP) is generally regarded as a safe procedure, with low rates of complications. However, when complications do arise, they can pose significant challenges to both patients and surgeons. Patient optimization and adherence to specific intraoperative protocols are crucial in mitigating the risk of surgical complications. Standardization of intraoperative management, including the administration of intravenous antibiotics, meticulous aseptic techniques, and antibiotic irrigation of the prosthesis, is paramount. Furthermore, having the appropriate set of instruments can reduce operative time and minimize tissue manipulation. While the literature predominantly focuses on outcomes such as infection, prosthesis malfunction, corporal perforation, and penile length loss, reports on managing retained prosthetic components are rare. This uncommon complication raises important considerations regarding whether foreign bodies should be left in place or removed during revision penile prosthetic surgeries. We present the case of a 49-year-old male who underwent IPP insertion. Following complications due to infection, salvage penile prosthetic surgery was performed 38 days after penile prosthesis insertion, using a temporary malleable implant. Subsequently, eight months later, the patient underwent surgery for the replacement of the malleable implant with an IPP. During the replacement procedure, the right-side malleable component was removed easily, while the left-side component was discovered to have the rear tip missing. Removal attempts using intracorporeal rigid cystoscopy and graspers were unsuccessful, necessitating a perineal counter incision for retrieval. After successfully removing the encapsulated extensor, a new IPP was successfully placed without complications.

OBJECTIVE To evaluate risk factors leading to corporal rupture after Collagenase Clostridium histolyticum (CCh). Peyronie's disease (PD) is a fibrotic condition of the penis characterized by abnormal plaque formation. Intralesional CCh is the only FDA -approved medication for PD, however, it can lead to corporal rupture, a potential surgical emergency. METHODS We retrospectively reviewed medical records from Veterans diagnosed with PD who were under treatment with CCh using the Veterans Administration Informatics and Computing Infrastructure (VINCI). Using International Classification of Diseases and Current Procedural Terminology codes, we identified men who suffered a corporal rupture after CCh. Individual charts were reviewed to determine potential risk factors and events leading to corporal rupture. RESULTS We identified 17,647 veterans who were diagnosed with PD, of which 8.7% (1541) received at least one injection of CCh for PD. Of them, 0.7% (11/1541) veterans suffered corporal rupture. Within these 11 patients, the median number of CCH injections was 6 with a median initial curvature of 35 degrees. Fracture occurred at a median of 8 days after CCH injection. The majority of fractures were secondary to spontaneous erections or sexual intercourse. Finally, six patients had their fracture repaired surgically while the remaining were managed conservatively. CONCLUSION Most fractures occurred within 2 weeks of CCh injections and were associated with sexual intercourse and spontaneous morning erections. UROLOGY 183: 117-120, 2024. Published by Elsevier Inc.

Abstract Introduction Peyronie’s disease (PD) affects between 0.4% and 13% of the male population. It leads to inelastic scar tissue in the tunica albuginea which in turn leads to penile curvature, deformity, and shortening. Collagenase clostridium histolyticum (CCH) is the only FDA approved intralesional medication for PD, but its efficacy in calcified PD remains controversial. The two large, double-blind, placebo controlled randomized clinical trials, known as the IMPRESS trials, excluded men with calcified plaques, which occurs in 25-30% of all patients with PD. Objective We aimed to evaluate change in penile curvature in men with calcified PD plaques after 8 injections of CCH in a large cohort of men Methods We prospectively evaluated men with PD presenting to our clinic from October 2018 to November 2020 electing CCH treatment. All men received a pre-treatment penile duplex ultrasound with artificial erection to assess degree of calcification and curvature. We used a grading system to assess calcification: Type 1: The plaque appears as a thickening of the tunica albuginea without acoustic shadowing; Type 2: A moderately calcified plaque with a typical ultrasound shadow, and Type 3: A severely calcified plaque with complete ultrasound shadowing. All men received CCH (0.58 mg) injected directly into the primary plaque at the point of maximal penile curvature using a standardized injection technique following the manufacturer's instructions. Cycles were terminated early if the patient was satisfied with the curvature or subjects reached less than 15 degrees. We remeasured the curvature in patients 4-6 weeks after the final CCH with artificial erection. All results are presented as mean ± standard deviation (SD) Results In total, 60 patents presented with calcified PD plaques with 32 (53.3%) receiving all 8 injections and another 5 patients were satisfied with results and elected to stop treatment. The remaining 23 (38.3%) discontinued before finishing; on average they received 5.6 injections. There were no differences in baseline characteristics between men who completed treatment and those that discontinued. In patients who were satisfied there was significant (p<0.0001) mean change per subject of -21.6 ± 19.9 degrees or 37.3% (Table 1). In the discontinued there was a mean change per subject of -12.8 ± 13.9 degrees (p=0.05). There was no significance difference in change in curvature between grade 2 (-24 ± 14.9 degrees) and grade 3 (-21.3 ± 23.4 degrees) calcified plaques (p=0.71) (Table 1). Conclusions Overall, CCH appears effective in the treatment of patients with calcified PD plaques. In patients who successfully completed 8 injections or was satisfied there was a significant difference in curvature after treatment and can help inform patients about treatment benefits despite calcification. Disclosure Yes, this is sponsored by industry/sponsor: Endo Pharmaceuticals Clarification Industry funding only - investigator initiated and executed study