Carrie Stewart

The Effect of Duration of Penile Traction Therapy in Patients Undergoing Intralesional Injection Therapy for Peyronie's Disease

PURPOSE The concomitant use of penile traction therapy with interferon α-2b has been previously described. We present an update on our clinical experience to assess the benefit and duration of daily traction. MATERIALS AND METHODS A retrospective review of patients who underwent interferon α-2b therapy between 2001 and 2012 was performed. Charts were reviewed and data collected regarding various patient demographics, vascular parameters, objective length and curvature measurements, and use of penile traction therapy. Penile traction therapy was further stratified according to duration of daily use. RESULTS A total of 112 patients underwent a median of 12 interferon α-2b injections (range 6 to 24). Daily use of penile traction therapy was reported by 31% of patients. There were no differences in patient demographics, initial vascular status, pretreatment stretched penile length, erect circumference and curvature between patients who followed a penile traction therapy regimen and those who did not. Overall, the use of penile traction therapy did not effect change in penile circumference (with therapy +3.2 mm [SD 6.5] vs no therapy +2.1 mm [SD 7.4], p=0.45), change in curvature (with therapy -8.1 degrees [SD 16.0] vs no therapy -9.9 degrees [SD 11.8], p=0.49) or change in stretched penile length (with therapy +2.4 mm [SD 0.9] vs no therapy +1.3 mm [SD 0.8], p=0.56). Men who used penile traction therapy 3 or more hours per day gained significantly greater stretched penile length compared to those who did not use penile traction therapy (4.4 mm [SD 0.5] vs 1.3 mm [SD 0.8], p=0.04). CONCLUSIONS Routine penile traction therapy during intralesional injection with interferon α-2b for Peyronies disease may result in a small but subjectively meaningful improvement in stretched penile length, without affecting curvature, if used for at least 3 hours a day.

Device Survival after Primary Implantation of an Artificial Urinary Sphincter for Male Stress Urinary Incontinence

Purpose: The AMS 800™ artificial urinary sphincter remains the gold standard for the surgical management of male stress urinary incontinence. We reviewed artificial urinary sphincter device survival after primary implantation. Materials and Methods: Retrospective data were collected from the AMS 800 patient information form database. Since 1972, 77,512 patient information forms for primary artificial urinary sphincter implantation have been completed in the United States. Following exclusion of procedures performed in children and females, and those labeled with an unknown surgical technique, 27,096 artificial urinary sphincter cases were included in the analysis. Collected variables included patient age, surgical approach, number of cuffs and surgeon volume. Measured outcomes included device explantation, device revision, component revision and time to each event. Results: Artificial urinary sphincter insertion was performed by low volume implanters in 22,165 (82.6%) cases. The approach was perineal in 18,373 cases (67.8%) and a tandem cuff was used in 2,224 cases (8.2%). Overall 5,723 cases required revision or explantation (21.1%). Younger age and penoscrotal approach were associated with higher device explantation and revision rates, while the use of a tandem cuff was associated with higher explantation rates. On multivariate analysis younger age, penoscrotal approach and use of a tandem cuff but not surgeon volume were significant factors associated with device explantation and component revision. Conclusions: These data provide a general overview of artificial urinary sphincter device survival and may serve urologists when counseling patients. Younger age, penoscrotal approach and use of a tandem cuff may be associated with inferior outcomes.

Avanafil for the treatment of erectile dysfunction

ABSTRACT Introduction: Erectile dysfunction (ED) affects millions of men worldwide, and the incidence of ED will continue to increase as the aging population grows. The first generation of phosphodiesterase-5 (PDE5) inhibitors, the mainstay of oral ED therapy, has revolutionized the treatment of this condition, but not without some drawbacks. Avanafil, the only United States and European Union-approved second-generation PDE5 inhibitor, is a safe and efficacious alternative to its predecessors. Areas covered: We reviewed the current and most up-to-date literature regarding Avanafil, as well as the pivotal trials that measured efficacy and tolerability. As Avanafil is still a relatively new drug, there is still a relative paucity of literature which inherently limited the search parameters. We searched the PUBMED database for articles detailing the clinical trials, chemistry, pharmacokinetics and dynamics, safety, and efficacy of the drug. Expert commentary: Avanafil’s unique pharmacologic profile both narrows and minimizes side effects while reducing the time of onset of action to half of its closest competitor, providing men who suffer with ED a return to a more spontaneous sex life.

Management of adult concealed penis using a meshed, split-thickness skin graft

INTRODUCTION Concealed penis (CP) is a rare problem faced by urologists and plastic surgeons. CP occurs secondary to trauma, obesity, or infection. Surgical treatment is individualized and based on patient and provider variables. We aim to review our recent experience using meshed split-thickness skin grafting (STSG) for CP management. METHODS A retrospective review was performed on patients who underwent STSG for CP at our institution. Records were reviewed for demographic, operative, and postoperative variables. Preoperative and postoperative photos were obtained to monitor cosmetic results. RESULTS Eleven patients underwent CP release with meshed STSG placement. All cases showed improved functional phallic length and good cosmetic results, regardless of etiology. CONCLUSIONS STSG is a viable option for penile coverage for management of this difficult-to-treat CP population. This primary or salvage modality offers excellent cosmetic results and may be used following prior reconstructive attempts.

Comparison of Adjuvant Radiation Therapy Before or After Artificial Urinary Sphincter Placement: A Multi-Institutional, Retrospective Analysis

OBJECTIVE To determine if the timing of radiation therapy on artificial urinary sphincter (AUS) impacts complication rates, revision rates, and number of pads per day after placement. METHODS A retrospective review was conducted of men with prostate cancer who underwent AUS placement and radiation therapy between 1987 and 2016. RESULTS Of 306 men, 292 (95.4%) received radiation before AUS placement (group 1) and 14 (4.6%) received radiation after AUS placement (group 2). Median follow-up was 30 months after AUS placement. Group 1 had 32 of 292 (11.0%) patients suffer from erosion, compared with 0 of 14 (0.0%) patients in group 2 (P = .191). None of the patients in group 2 had infection or mechanical failure. The number of patients who received revision in group 1 was 91 of 292 (31.2%) and in group 2 was 2 of 14 (14.3%) (P = .180). The number of pads used per day in group 1 before and after AUS placement was 5.24 ± 3.12 and 1.13 ± 1.31, respectively (P <.001). In group 2, the number of pads used per day before and after AUS placement was 6.09 ± 1.97 and 1.53 ± 0.99, respectively (P <.001). There was no significant difference in the average number of postoperative pads used per day between group 1 and group 2 (P = .907). CONCLUSION The timing of radiation therapy does not appear to significantly affect complication rates or urinary continence, as measured in pads used after AUS placement. This multi-institutional retrospective analysis showed similar erosion and revision rates when radiation occurred after AUS placement and demonstrates preliminary safety and feasibility of the administration of radiation after AUS placement.

MP46-06 COMPARISON OF ADJUVANT RADIATION THERAPY BEFORE OR AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT: A MULTI-INSTITUTIONAL ANALYSIS

INTRODUCTION AND OBJECTIVES: Artificial Urinary Sphincter (AUS) remains the gold standard in the management of male stress urinary incontinence following radical prostatectomy. However, the impact of AUS placement before or after adjuvant radiation therapy has limited coverage in the literature. The objective of this study was to determine if the timing of radiation therapy has an impact on AUS outcomes, as well as identify predictors of AUS-related complications. METHODS: A retrospective review was conducted across five academic institutions of men who received AUS placement and adjuvant radiation therapy between 1993 and 2016. A total of 306 men were included in the study. Out of the 306 men, 292 (95.4%) received radiation before AUS placement (Group 1) and 14 (4.6%) men received radiation after AUS placement (Group 2). Collected variables included demographics, type of prostate cancer therapy, and AUS device specifications. Primary endpoints included complication rates, revision rates, and number of pads per day before and after AUS treatment. Bivariate analysis was used to examine the association between pretreatment comorbidities and the incidence of AUS-related complications postoperatively. RESULTS: Median duration of follow-up for the entire cohort was 30 months (range 4-148 months). Group 1 was followed for a median of 29 months (range 4-148 months), while Group 2 was followed for a median of 49 months (range 12-141 months). There was no difference between groups in the percentage of men who experienced postoperative complications (P 1⁄4 0.832). In Group 1, 26.0% of patients experienced postoperative complications while 28.6% of patients in Group 2 experienced postoperative complications. While the number of pads per day decreased significantly from before AUS placement to after AUS placement, there was no significant difference in the average number of pads used per day between Group 1 and Group 2 (P 1⁄4 0.907). The number of pads used per day in Group 1 before AUS placement was 5.24 3.12 which decreased to 1.13 1.31 (P < 0.001). In Group 2, the number of pads used per day before surgery was 6.09 1.97 which decreased to 1.53 0.99 pads per day after AUS placement (P < 0.001). The percentage of men requiring revision in Group 1 was 31.2%, while the percentage of revisions in Group 2 was 14.3%(P 1⁄4 0.028). The median time to revision was 14 months and 18.5 months for Group 1 and Group 2, respectively. The presence of peripheral vascular disease (PVD) and coronary artery disease (CAD) was associated with increased incidence of AUS-related complications (primarily refractory incontinence and cuff erosion) in both Groups (P 1⁄4 0.032). The following factors were not significant: age, race, smoking, hypertension, diabetes mellitus, dyslipidemia, BMI, AUS device specifications, type of radiation therapy. CONCLUSIONS: The timing of radiation therapy does not have a significant impact on complication rates or urinary continence as represented by number of pads used post-AUS placement. There is a non-statistical association between lower revision rates in patients who underwent radiation after AUS placement, as compared to before AUS placement. Patients with pre-existing PVD or CAD may experience more frequent postoperative complications, but this study is underpowered. Further research is needed to confirm these findings.

Technology Based Treatment for UreteroPelvic Junction Obstruction

Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.Abstract Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.

From Endopyelotomy to Robotic Pyeloplasty: What a Safari!

Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.Abstract Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.

MP43-09 FAILURE TO ATTAIN STRETCHED PENILE LENGTH AFTER INTRACAVERNOSAL INJECTION OF A VASODILATOR AGENT IS PREDICTIVE OF VENO-OCCLUSIVE DYSFUNCTION ON PENILE DUPLEX DOPPLER ULTRASONOGRAPHY

INTRODUCTION AND OBJECTIVES: Men who are considering vasectomy as a means of contraception may harbor significant anxiety regarding their future sexual potency. As a result, couples may choose other forms of contraception with lower efficacy. While prior studies have demonstrated high satisfaction rates after vasectomy, no study to date has provided an objective measure of sexual function after vasectomy. Therefore we sought to determine the impact of vasectomy on the frequency of sexual intercourse. METHODS: We analyzed data from cycles 6 (2002) to 7 (20062008) of the National Survey of Family Growth (NSFG) to compare the frequency of sexual intercourse (within the prior 4 weeks) for men who had undergone vasectomy versus those who had not. We excluded men who had never had sex, as well as men under the age of 30, since vasectomy prior to this age is less common. We then constructed a multivariate logistic regression model to adjust for age, marital status, race, education, health, BMI, children, and income. RESULTS: A total number of 3798 men met the criteria for our study; 317 (8.3%) had undergone vasectomy. For men who had undergone vasectomy, the average frequency of sexual intercourse was 5.8 times per month compared to 4.8 times per month for nonvasectomized men. Only 6% of vasectomized men did not have sexual intercourse in the prior 4 weeks, compared to 16% of nonvasectomized men. In addition, 66% of vasectomized men and 53% of non-vasectomized men had sexual intercourse at least once a week. After adjusting for demographic, socioeconomic, reproductive, and health factors, men utilizing vasectomy had a 77% higher odds (95% CI 2-205%) of having sexual intercourse at least once a week, versus less than once a week. CONCLUSIONS: Vasectomy does not adversely impact sexual frequency. This finding may be helpful to couples as they consider their contraceptive options.