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

© The Canadian Journal of Urology TM : International Supplement, August 2020 52 CT Cavernosography: a Patient-Centered Approach to Understanding Functional Penile Abnormalities Diana Aponte-Colon, BS 1 , James Trussler, MD, MS 2 , MohannedAlnammi, MD 2 , Sebastian Flacke, MD 2 , Andrew McCullough, MD 2 1 Tufts University School of Medicine, Boston, MA; 2 Lahey Hospital and Medical Center, Burlington, MA Introduction: Patient-centered care focuses on maximizing patients’ physical and emotional well-being. A key aspect to delivering patient-centered care is creating a partnership between the patient and practitioner and integrating both physician and patient knowledge through shared decision-making. Men with functional penile abnormalities are at higher risk of experiencing physical and emotional dissatisfaction. Interventions aimed at patient education may significantly improve patient quality of life and potentially affect response to treatment. CT cavernosography (CTC) is an emerging imaging technique that has been used to evaluate penile anatomy in conditions such as Peyronie’s disease and erectile dysfunction. The aim of this study was to use a patient- reported outcome questionnaire to determine the efficacy of CTC in helping patients with functional penile abnormalities understand their condition and treatment options. We also assessed the pain attributed to the use of CTC and whether patients thought this was a valuable tool in the diagnosis of their condition when taking into account the discomfort of the test versus the information gained. Materials & Methods: Before the procedure, patients were informed about the role for CTC in evaluating their condition. The method for CTC has been previously described. Briefly, a maximal erection was induced by combination of intracavernosal injection and inflation with 50% iodinated contrast media. A pelvic CT scan was then obtained. After the scan, images including 3D reconstructions were discussed with the patients and a 6-item questionnaire was administered for purposes of quality control. The 6 questions concerned pain associated with the procedure, informedness about the procedure, impact of the CTC on patient understanding of the disease process and treatment options, impact of the CTC on decision making, and value obtained from the CTC results. Patients rated the questions on a scale of 1-5 or 1-10. WITHDRAWN 54 53 Penile Prosthesis Placement in Patients with Corporal Fibrosis Secondary to Infection or Priapism: Outcomes and Complications Priyanka Bearelly, MD, MPH 1 , Shu Pan, MD 2 , Dayron Rodriguez, MD, MPH 3 , Michael Rezaee, MD 4 , Michael Witthaus, MD 5 , Nannan Thirumavalavan, MD 6 , Kevin Krughoff, MD 4 , Martin Gross, MD 4 , Ricardo Munarriz, MD 1 1 Boston University, Boston, MA; 2 NorCal Urology, Walnut Creek, CA; 3 UT SouthwesternMedical Center, Dallas, TX; 4 Dartmouth-HitchcockMedical Center, Lebanon, NH; 5 University of Rochester, Rochester, NY; 6 Case Western Reserve University, Cleveland, OH Introduction: Corporal fibrosis can make the insertion of a penile prosthesis very challenging and is associated with high complication rates. Common causes of this pathology include prior infection, history of priapism, radiation therapy, poorly controlled diabetes, Peyronie’s disease, etc. Dilation of the corpora both distally and proximally often require the use of cavernotomes, Rarely, sharp corporal excision may be necessary if the corporal fibrosis is severe. Objective: The aim of this study was to investigate the outcomes and complications of penile prosthesis placement in patients with corporal fibrosis. Materials & Methods: This is a single institution retrospective IRB approved study of 34 patients (mean age 52 years, range 31-74 years) , with corporal fibrosis who underwent placement of penile prosthesis during a 16-year period. Results: Etiologies of fibrosis included history of penile prosthesis infection (41.2%, 14/34), priapism (41.2%, 14/34), erosion of penile implant requiring explant (11.8%, 4/34), and poorly controlled diabetes (5.9%, 2/34). With regards to surgical techniques, sharp corporal excision was utilized in 5 patients (14.7%), cavernotomes in 7 patients (20.6%), and a combination of both sharp excision and cavernotomes in 17 patients (50%). In 5 patients (14.7%) where fibrosis was notable, the surgeons were able to dilate the corpora without the aforementioned specialized techniques, although more difficult. Complications includedmalpositioned prosthesis (8.8%, 3/34), distal erosion (2.9%, 1/34) and infection (2.9%, 1/34). Conclusions: Penile prostheses can safely be placed in patients with severe corporal fibrosis. However, surgeons must be prepared to use cavernotomes or sharp corporal excision in order to effectively dilate the corpora. Intraoperative Use of Vancomycin Paste during Penile Prosthesis Placement: Initial Outcomes Priyanka Bearelly, MD, MPH 1 , Maria D’Amico, MD 1 , Shu Pan, MD 2 , Nannan Thirumavalavan, MD 3 , Martin Gross, MD 4 , Pedro Maria, MD 5 , Ricardo Munarriz, MD 1 1 Boston University, Boston, MA; 2 NorCal Urology, Walnut Creek, CA; 3 Case Western Reserve University, Cleveland, OH; 4 Dartmouth-Hitchcock Medical Center, Lebanon, NH; 5 Montefiore Medical Center, Bronx, NY Introduction: Penileprosthesesaresafeandeffective treatmentoptions in themanagement of severe vasculogenic ED. It is associated with high satisfaction rates in addition to low and acceptable complication rates. Penile prosthesis infection is rare (0.5% to 3%) but can be physically and emotionally devastating for the patient. Although these rates have decreased over the past years with surgeon and device dependent improvements, innovative infectionpreventionmeasuresarewelcome.Vancomycinpastehasbeenusedby cardiothoracic surgeons since at least 2007 in an effort to reduce sternal wound infections. Numerous studies have shown that the use of vancomycin paste has an excellent safety profile and has significantly reduced wound site infections, both deep and superficial. We have adopted its use to provide prolonged focal antibiotic exposure around the penile prosthesispump,a location that issusceptible to themajorityofpenileprosthesis infections. Objective: The aim of the study is to determine whether vancomycin paste can be safely used intraoperatively as an additional step for infection prevention during penile prosthesis placement. Materials & Methods: A multi-institutional chart review of patients who underwent placement of a virginal inflatable penile prosthesis (IPP) with intraoperative use of vancomycin paste (3 gm) was conducted to determine initial outcomes.Adverse outcomes were of particular interest andwere categorized in the followingmanner: penile prosthesis pump-related issues such as fibrosis, persistent pain, and difficult manipulation; as well as standard complications including infection, erosion, hematoma and complete device malfunction. Results: From April 2019 to October 2019, 90 patients underwent virginal IPP surgery during which vancomycin paste (3 gm) was placed in the scrotum to encircle the pump. Surgical technique, use of irrigations, and drain placement remained consistent per routine protocol. To date, five patients have experienced adverse events, including deep wound infection, superficial wound infection, and scrotal hematoma. Of the five patients, only one experienced a true infection requiring explant, ultimately demonstrating an infection rate of 1.1%. Conclusions: Vancomycin paste is a safe intraoperative infection prevention measure during IPP surgery. The infection rate within this cohort of patients is in congruence with what is found in today’s literature. Nonetheless, no conclusions can be drawn regarding the ability of Vancomycin paste to prevent infections. Future prospective studies are necessary to further examine its efficacy. 51 24 Results: A total of 29 men aged from 22 to 71 years who underwent CTC for erectile dysfunction (45%), erectile dysfunction with comorbid penile curvature (34%), or other functional penile abnormalities (21%) between October 2019 and March 2020 were included. Patients reported feeling well-informed about the need for the CT scan (M = 4.8/5, SD = 0.8). They also reported that the CT scan gave them a clear understanding of their condition (M = 4.8/5, SD = 0.8) and helped them understand their treatment options (M = 4.7/5, SD = 0.8). Additionally, the scan helped them decide on their next treatments (M = 4.7/5, SD = 0.8). The average pain score attributed to the CTC was low (M = 2.9/10, SD = 2). Fifteen patients required either no pharmacologic reversal or a single dose of phenylephrine. Four patients had a prolonged erection after the procedure requiring corporal aspiration. After weighing the discomfort of the test versus the information gained, patients felt that the CTC was important in the diagnosis of their condition (M = 4.8/5, SD = 0.4). Conclusions: The use of CTC in patients with functional penile abnormalities is associated with low pain, improved patient understanding of the disease and treatment options, and high patient satisfaction. Scientific Session V: ED/Infertility