Abstracts from the New England Section of the AUA 2020: A Virtual Experience

© The Canadian Journal of Urology TM : International Supplement, August 2020 48 Access to Male Fertility Preservation Information and Referrals at National Cancer Institute Cancer Centers Kenneth A. Softness, MD 1 , Aaron Perecman, MD 4 , Taylor P. Kohn, MD 3 , Robert J. Carrasquillo, MD 1 1 Beth Israel Deaconess Medical Center, Boston, MA; 2 Frank H. Netter, MD School of Medicine, New Haven, CT; 3 Johns Hopkins University, Baltimore, MD Introduction: Future fertility and sexual function are critical quality-of-life issues for male cancer survivors.Access to subspecialists is not uniform throughout the United States. We sought to identify access gaps in male sexual health and fertility care at National Cancer Institute (NCI)-designated cancer centers (CC) across US Census Regions. Materials & Methods: 64 NCI center websites (14 CC and 50 comprehensive CC) were examined for language related to male sexual health and fertility. A phone-based survey was used to establish CC referral patterns to andrologists and sperm banks. The Society for the Study of Male Reproduction (SSMR) membership directory was used to determine geographic locations for andrologists relative to each CC. Fisher exact test and ANOVAwere used for categorical and continuous univariate comparisons, respectively. Multivariate logistic and linear regression were used to control for region and center type when assessing binary and continuous variables, respectively. Statistical significance was set to p < 0.05. Results: Presence of information regarding fertility preservation, sexual health and male-specific fertility preservation was not associated with region (p = 0.18, 0.17, 0.48, respectively), while presence of fellowship-trained andrologists within 5 miles of a CCwas associated with region, favoring the Northeast (p = 0.014). On logistic regression, centers whose websites discuss fertility were more likely to refer patients to sperm banks (OR 3.48 [1.11-12.29]). On linear regression, comprehensive CC were not more likely to have established referral patterns to andrologists or sperm banks, or be geographically closer to andrologists when compared to non-comprehensive CC (p = 0.75). Conclusions: We demonstrate geographic differences in access to sexual health and fertility care at NCI-designated CC in the United States, with greater representation of andrologists in the Northeast. The association between online information regarding male fertility preservation and referral access to sperm banks suggests that certain centers may greater emphasize fertility and sexual health care compared to others. Our methods of data collection are tools readily available to patients and can be a focus of efforts to improve access to care in this population. Angiographic Observations Derived From CT Cavernosography JamesTrussler,MD,MS 1 ,DianaAponte-Colon,BA 2 ,MohannedAlnammi,MD 1 ,Sebastian Flacke, MD 1 , Andrew McCullough, MD 1 1 Lahey Hospital and Medical Center, Burlington, MA; 2 Tufts University School of Medicine, Boston, MA Introduction: Understanding penile arterial anatomy and its preservation is of interest to reconstructive and oncologic surgeons. Traditionally, the predominant cavernosal arterial supply is thought to be the cavernous artery (CA), originating from the internal pudendal artery (IPA). Penile duplex dopplers have demonstrated the existence of accessory cavernous arteries originating from the dorsal artery of the penis. Assessment of the arterial anatomy has been limited to imprecise doppler ultrasound and invasive fluoroscopic angiography. Herein we describe the ability of CTC to delineate heretofore undescribed arterial anatomy of the penis. We describe our observations on the importance of the contribution of the dorsal penile artery (DA) to the blood supply of the corpora cavernosa in men evaluated by CTC. Materials & Methods: CTC images were reviewed from a sequential cohort of men. Briefly, a maximal erection is induced by intracavernosal injection (ICI) and inflation with 50% iodinated contrast media.ACT scan of the pelvis is then obtained. Imaging was reviewed to delineate the arterial anatomy with respect to the CA and DA perforators distal to the pubic symphysis. Results: 14 men had imaging available for review collected between October 2019 and March 2020. The average age was 59.4 years and BMI 28.7; 7.1% of patients had cardiac disease or diabetes, while 14.2% had sleep apnea. Erectile dysfunction was the primary indication in 71.4%, 42.9% had comorbid penile curvature. 42% of men had an identifiable CAwith amean diameter of 1.95mm. 78.6%of men had at least one identifiable perforating branch of the dorsal artery into the cavernosum, the average count being 2.83 (range 0-6). The mean penetrating angle was 51.8°. The mean distance from the pubic symphysis to the first, second, and third perforating arteries was 2.22 cm (range 0.3-7.3), 3.27 cm (range 1.0-5.3), and 3.95 cm (range 1.2-5.7), respectively, with a mean diameter of 1.76 mm. Conclusions: This is the first time that CTC has been used to describe variability in penile arterial anatomy. Our results suggest that most men with ED have multiple accessory arteries penetrating the cavernosa distal to the pubic symphysis. These arteries, in aggregate, may provide major blood flow to the cavernosa. The results of this study have implications for the reconstructive and oncologic surgeon where DA’s originating from the accessory pudendal arteries may be sacrificed. Additionally, these results may call into question the predictive value of penile dopplers where the exact artery that is being measured is uncertain. Penile arterial anatomy is more diverse than previously reported. Based on our CTC study, the corpora cavernosa receive significant blood supply from the dorsal arteries Limitations of this study include small sample size, observational nature, and lack of normal controls. 47 Scientific Session V: ED/Infertility 22