Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts 52 Partner Involvement Reduces Postoperative Care Burden Following Penile Prosthesis Placement Amanda R. Swanton, MD/PhD 1 , Ricardo M. Munarriz, MD 2 , Martin S. Gross, MD 1 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 2 Boston University School of Medicine, Boston, MA, USA Introduction: The spouses and partners of patients undergoing implantation of an inflatable penile prosthesis (IPP) are often active participants in the perioperative process. Many urologists encourage partner involvement for penile implant patients, but there is little information on the role partners play perioperatively. We analyzed the effect of perioperative partner involvement on planned postoperative care. Materials & Methods : This is a retrospective study conducted using data obtained from primary IPPs performed by a single surgeon between October 2016 and January 2021. A standardized postoperative course was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine the influence of partner involvement on planned postoperative scheduled visits. Results: During the study period, n = 170 primary IPPpatients were identified and 147 (67%) of these patients had partners. Partners were involved in all perioperative visits for 92 patients (54%). Unplanned follow up visits were seen for 58 patients (34%) between 0-6 weeks and for 28 patients (17%) after 6 weeks postoperatively. Partner involvement was associatedwith a reduced odds of additional follow up visits, both at 0-6 weeks (unadj: OR 0.43, 95% CI 0.23-0.83; adj: OR 0.40, 95% CI 0.20-0.79) and after 6 weeks (unadj: OR 0.32, 95% CI 0.13-0.76; adj: OR 0.33, 95% CI 0.13-0.81), both in unadjusted analysis and when adjusted for obesity and presence of complications. Clavien-Dindo complications were identified in 29 patients (17%) intraoperatively or postoperatively. Mean surgical time was 69 minutes (SD = 19). Mean patient age was 62 years (SD = 9). Comorbidities included obesity (52%), diabetes (37%), hyperlipidemia (72%), and hypertension (84%). Conclusions: Partner involvement equated to a 2.5 fold decrease in the odds of unplanned postoperative visits among primary IPP patients. Though the mechanism of this reduction is unclear, having partners attend perioperative visits is easily implemented, low cost, and minimal risk. We would recommend that urologists routinely encourage patients considering insertion of a penile prosthesis involve their partners in perioperative visits. Scientific Session V: ED/Infertility 53 TheUse of Adjuvant Dexamethasone andDexmedetomidine inBupivicaine Penile Nerve Block During Penile Prosthesis Surgery for Peri-operative Analgesia Molly E. Reissmann, MD , Michel Apoj, MD, Ricardo Munarriz, MD Boston University Medical Center, Boston, MA, USA Introduction: Inflatable penile prosthesis (IPP) surgery is the gold standard treatment for medication-refractory erectile dysfunction. While results are overall highly satisfactory, post-operative pain and narcotic requirement remains a concern. Use of intra-operative dorsal penile nerve block with long acting local anesthetic can improve post-operative analgesia. Recent studies in non-urologic surgical fields have demonstrated prolonged analgesia but minimal adverse effects with local nerve blocks containing long acting local anesthetic mixed with either dexamethasone or dexmedetomidine. The aim of this study was to evaluate the analgesic effectiveness of the addition of these adjuvant medications to bupivacaine penile nerve block as compared to plain bupivicaine block during primary IPP surgery. Materials &Methods: This is a retrospective single institution IRB-approved comparative study of intraoperative dorsal penile nerve block with either plain 0.25% bupivacaine versus combination 0.25% bupivicaine + 70 mcg dexmedetomidine + 4 mg dexamethasone in patients undergoing primary IPP surgery (December 2019 to 2020). The primary outcome was pain level (Analog Pain Scale) throughout the first 24 hours post-operatively (PACU arrival, 2, 6, 12, 18, and 24 hours post operatively). The secondary outcome measures were intra- and post-operative narcotic consumption (total morphine equivalents, TME). Results: 62 patients (mean age 60.5 years) were included in the study. 32 received plain bupivacaine, whereas 30 received the combination block. Mean pain levels in PACU, 2 hours, and 12 hours post-operativelywere significantly lower in the combination block group (0 vs. 4; 1 vs. 5; 3 vs. 5.5; p<0.05). Mean total narcotic consumption (TME) was lower for the combination block (42 vs. 65, P<0.05). There was no significant difference in the intraoperative narcotic administered between the treatment groups. Two patients who received the combination block had intraoperative bradycardia but did not require intervention. Conclusions: Intraoperative dorsal penile nerve block consisting of long acting local anesthetic mixed with dexmedetomidine and dexamethasone can safely enhance immediate post-operative analgesia and decrease opioid consumption in the first 24 hours after surgery. A prospective randomized study is underway to further evaluate outcomes. This type of combination penile nerve block may also be a useful tool for other penile and scrotal surgeries. Defining the Incidence of Postoperative Scrotal Hematoma After Three- piece Inflatable Penile Prosthesis Surgery Rutul D. Patel, MBS 1 , Avery E. Braun, MD 2 , Architha Sudhakar, MD 2 , Jacob W. Lucas, MD 2 , Martin S. Gross, MD 3 , Jay Simhan, MD 2 1 New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA; 2 Einstein Healthcare Network, Philadelphia, PA, USA; 3 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction: Development of scrotal hematoma is a rare but serious complication following inflatable penile prosthesis (IPP) surgery. Multiple techniques to mitigate hematoma formation are implemented by penile implant surgeons, including temporary device inflation, Mummy wrap usage, drain placement and appropriate suspension of anticoagulation (AC). We assessed the incidence of scrotal hematoma formation in primary and complex IPP recipients managed with these techniques. Materials & Methods: This is a multicenter retrospective review of 246 patients from 2/2018 to 12/2020 with 194 (78.9%) primary and 52 (21.1%) complex IPP surgeries. Revisions, removal/replacements, or IPPs with concomitant procedures were considered complex. All patients underwent surgery with appropriate suspension of AC as well as postoperative Mummy wrap and drain placement. Drain outputs on postoperative day (POD) 0 and 1 were collected. Device activation varied between two and four weeks, based on surgeon preference. Incidence of postoperative bleeding with hematoma formation was assessed along with risk factors and postoperative management. Results: Primary and complex IPP hematoma patients were similarly matched groups compared to non-hematoma formers. The incidence of postoperative hematoma formation in complex cases (5/52, 9.6%) is more than double that of primary cases (7/194, 3.1%) (HR=2.61). Complex IPP hematomas have a higher propensity for OR evacuation than primary hematomas (p=0.028). AC status impacted 25% (3/12) of hematoma formers with 40% (2/5) of complex hematomas related to AC resumption (HR=2.40). Patients with scrotal hematomas had increased pain on the postoperative night immediately following surgery (Visual Analog, VAS, score 5.3 vs. 3.2, p=0.012). However, hematoma formers had similar VAS scores in PACU (2.7 vs. 1.9. p=0.485) and POD1 (4.5 vs. 3.4, p=0.316) and comparable drain outputs to non-hematoma patients on POD0 (66.8cc vs. 49.6, p=0.488) and POD1 (20.0cc vs. 40.3, p=0.114). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Penoscrotal approach accounted for 6/12 (50%) of hematomas (p=0.298). Conclusions: Complex IPP surgeries (revisions or concomitant cases) are more likely to result in hematoma requiring OR management with anticoagulated status as an associated risk factor. It may be prudent tomanage complex IPP cases with prolonged drainage along with an increased duration of holding postoperative anticoagulation. 51 27