Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Moderated Poster Session 6: Trauma/Sexual Dysfunction A Comparison of the Psychosocial Impact of Penile Implant and Intracavernosal Injection Therapy for Erectile Dysfunction Using the Self- Esteem and Relationship (SEAR) Questionnaire A. Salib, T. Tidwell, K. Berry, P. Chung Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA Introduction andObjective: The few studies that do compare penile implants (PI) and intracavernosal injections (ICI) focus predominantly on sexual function leaving self-esteem and relationships understudied. The Self-Esteem and Relationship (SEAR) questionnaire was developed to provide a reliable tool to assess psychosocial variables of ED treatments. We hypothesized that patients with PI would have higher SEAR scores compared to patients treated with ICI. Methods: IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. SEAR questionnaire results were calculated according to the previously described formula and individual questions and domains were compared using T-test statistics. Results: Fifty patients (25 PI, 25 ICI) agreed to be interviewed for this study. Prostate cancer (n=21, 45%) and vascular disease (n=7, 14%) were the leading cause of ED in our cohort. PI patients on average suffered from ED for a longer period than patients on ICI (5.6 vs. 2.7 years, p=0.005). There were no differences in age or marital status. PI patients reported numerically higher total SEAR scores than PI patients (63 vs. 53, p=0.12). PI patients reported higher sexual relationships domain scores than ICI patients (64 vs. 46, p=0.04), especially in “I felt confident that during sex my erection would last long enough” (p=0.004), “I was satisfied with my sexual performance” (p=0.05), and “I felt confident about performing sexually” (p=0.02). There were no statistical differences in the confidence domain (p=0.89) or self-esteem (p=0.68) and overall relationship (p=0.80) sub-domains. Conclusions: PI patients reported higher sexual relationship domain scores than ICI patients, while confidence, self-esteem, and overall relationships were similar. Regular use of the SEAR questionnaire may help to identify areas of post-treatment psychosocial needs in ED patients that may benefit from support groups or discussion with a counselor. MP6-04 Does a Preemptive Quality of Life Clinic Increase Utilization of Treatment Options Following Radical Prostatectomy? P. Prillaman, E. Roger, M. Monn, G. Mansour, J. Delong, R. Virasoro, K. McCammon Eastern Virginia Medical School, Virginia Beach, VA, USA Introduction and Objective: A men’s health clinic (MHC) for patients undergoing radical prostatectomy (RP) was started to facilitate return of erectile function and continence. We hypothesized that MHC attendance would lead to a greater variety ED treatment as well as better incontinence care. Methods: A retrospective cohort study was conducted of men undergoing surgery between Sept 2014 and Dec 2018. Primary outcomes were usage of ED aids, time to usage, and incontinence rates based on pads per day and need for incontinence procedure. We studied pelvic floor physiotherapy (PFPT) enrollment. Patients with follow-up less than 4months were excluded. Results: 404 men were included. Median (IQR) follow-up was 34.9 (SD 18.6) months. 160 (39.6%) men attended MHC. The cohorts were similar in regard to age, BMI, co-morbidities, and nerve-sparing. Men attending a MHC had higher utilization of daily tadalafil (86.9% vs. 66.4%, p<0.0001), on-demand PDE5i (73.8% vs. 64.0%, P=0.04), VED (33.2% vs. 16.0%, p=0.0001), ICI (24.4% vs. 14.3%, p=0.01), and IPP (6.3% vs. 2.5%, p=0.06). Time to initiation of on- demand PDE5i was 6.6 months (SD 8.1), VED at 6.1 months (SD 5.8), ICI at 13.8 months (SD 8.5), and IPP at 24.2 months (SD 10.0) Time to treatment was not significantly different between cohorts (p>0.05). We found an association between MHC attendance and PFPT (OR 2.89, CI: 1.55-5.42). We did not find a significant difference in pad usage at 1 (p=0.12) and 3 (p=0.31) months, nor between MHC attendance and undergoing an incontinence procedure (OR 4.71, CI: 0.94-23.66). Conclusions: Men attending MHC are offered more options for ED and are more likely to pursue PFPT. There was no increased utilization of incontinence procedures. Attendance in aMHC should be advocated for men following RP. MP6-03 Inflatable Penile Prosthesis Patients Treated with Multimodal Analgesia Have Reduced Risk of Prolonged Opioid Dependence A. Braun 1 , A. Sudhakar 1 , J. Lucas 1 , R. Patel 2 , M. Gross 2 , J. Simhan 1 1 Einstein Healthcare Network, Philadelphia, PA, USA; 2 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction and Objective: Utilization of multimodal analgesia (MMA) in inflatable penile prosthesis (IPP) surgery has demonstrated durable results in reducing opioid usage and improving pain control postoperatively. Rates of opioid dependence following opioid-based (OB) or MMApain management in penile implant recipients has yet to be defined. We assessed the risk of prolonged narcotic usage following IPP surgery by comparing opioid-based management patients with multimodal analgesia patients. Methods: This is a multicenter retrospective review of 344 three-piece IPP recipients who underwent implantation from 12/2014-12/2020. 133 patients (38.7%) were managed with OB regimen while 211 patients (61.4.0%) received MMA. Prolonged opioid dependence was defined as opioid prescriptions 90 days after surgery. Perioperative and postoperative opioid usage was assessed with thePrescriptionDrugMonitoringProgram(PDMP). Patientswere excluded if PDMP data was incomplete or preexisting dependence was identified. Results: Postoperative inpatient narcotic use was higher in the OB group, with substantially more total morphine equivalents (TME) used (41.3 vs. 13.8, p<0.001). After discharge, the OB group required greater narcotic refills (31.5% vs. 9.8%, p<0.001) and higher total refill TME (276.0 vs. 22.3, p<0.001). IPP recipients managed with MMA had an absolute risk reduction of 3.6% in developing opioid dependence (ARR=0.036) while more OB patients developed opioid dependence (6/133, 4.5%) despite smaller OB cohort size. In those with prolonged opioid dependence, all 6 OB patients were primary IPPs while MMA patients were predominantly complex revision cases (p=0.045). OB and MMA groups demonstrated similar ages, incidence of chronic pain, and diabetes but differed in BMI (32.0 vs. 30.6, p=0.045) and race (p=0.001). Intraoperative factors did not demonstrate statistical significance. Conclusions: Our series demonstrates that MMA recipients have reduced risk of prolonged narcotics dependence compared to OB, particularly after primary IPPs. Substantial differences in opioid usewere noted postoperatively withMMApatients requiring fewer inpatient TMEs and fewer narcotic refills. MP6-02 40