M. Khera

The 20‐Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men

INTRODUCTIONnTestosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).nnnAIMnTo quantify the incremental cost burden imposed by TDs cardiometabolic sequelae.nnnMETHODnIncidence, prevalence, and mortality of these conditions were collected for men ages 45-74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.nnnMAIN OUTCOME MEASURESnAdjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.nnnRESULTSnActual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45-74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately

Emerging concepts in erectile preservation following radical prostatectomy: a guide for clinicians.

8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately

Mesenchymal Stem Cell Therapy for the Treatment of Erectile Dysfunction

190-

The Evolution of the Inflatable Penile Prosthesis Reservoir and Surgical Placement

525 billion in inflation-adjusted U.S. health care expenditures.nnnCONCLUSIONnTD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care.

334 Post Priapism PROPPER Data Shows Good Satisfaction and Functional Outcomes

Radical prostatectomy (RP) is a commonly performed procedure for the management of prostate cancer. While documented oncologic outcome for early stage disease is excellent, functional impairments such as incontinence and erectile dysfunction (ED) are common after the procedure. Recent evidence has implicated cavernous nerve damage and subsequent corporal oxygen deprivation, as well as corporal inflammation, in the pathogenesis of post-RP ED. Targeted therapies such as oral phosphodiesterase-5 inhibitors, mechanical vacuum erection devices, local alprostadil delivery and testosterone replacement (for hypogonal patients) have demonstrated some efficacy in the management of post-RP ED. This review aggregates much of the recent data in support of these therapies and critically reviews them. The article then presents tools to assess patients and partner sexual function to aid in identifying and monitoring post-RP ED. Finally, the article describes a protocol in use at Baylor College of Medicine as a guide toward the development of a protocol for erectile preservation (EP). The purpose of this work is to educate clinicians on emerging concepts in EP and provide an implementable protocol for use in practice.

219 Curvature Correction Techniques For Residual Curvature After Penile Prosthesis Placement: From Personal Opinion To Objective Data

E rectile dysfunction (ED) is defined as the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual relations. ED is a common global problem affecting an estimated 150 million men worldwide, and it is estimated that by the year 2025, 322 million men will be affected by this disease [1]. However, there are many limitations with the current medications available for the treatment of ED. A study by Carvalheira et al. found that of those patients who were prescribed a phosphodiesterase type 5 inhibitors (PDE5), only 45% were still using the medication over the 3-year follow-up period [2]. Of the patients that discontinued the PDE5, 38% reported the reason to be ineffectiveness of the drug. Over the past decade, there has been growing interest in the use of stem cells to treat ED. Stem cells are by definition capable of selfrenewal and differentiation into one or several more terminally differentiated phenotypes. Furthermore, (mesenchymal) stem cells (MSC) have been described as site-regulated “drugstores” in vivo as a result of the discovery of their potent trophic and immunomodulatory activities [3]. Unlike conventional treatments currently used for the treatment of ED, these properties render stem cell therapy an excellent candidate to offer a potent treatment and potentially a cure for the ED patient. Contemporarily, a major concern regarding stem cell therapy for ED is the inappropriate claim made by centers regarding the efficacy of stem cells for ED patients. The majority of the research conducted with stem cells for this indication has been in the preclinical investigational phase, and thus represents level 5 evidence at best. There has been only one published clinical trial with seven patients with diabetes suggesting some transient short-term benefits with umbilical cord stem cells to treat ED [4]. Despite the lack of clinical data, there are numerous centers throughout the world offering patients stem cells to treat this condition, charging cash for this treatment and in many cases not even offering true stem cells. The International Society for Cellular Therapy (ISCT) has recommended minimum criteria for defining multipotent human mesenchymal stem stromal cells. These cells must express CD105, CD73, and CD90, and they must lack expression of CD34, CD45, CD14, CD11b, CD79-α, CD19, and HLA-DR surface molecules. MSC must also differentiate into osteoblasts, chondroblasts, and adipocytes ex vivo. The concern is that many of the centers offering stem cell therapy for ED do not follow the recommended criteria set out by the ISCT, and these centers are not being monitored for what type of cells are actually being injected. The first stem cell study for the treatment of ED was published in 2004. This study was the only study to use embryonic stem cells to treat ED. There have up until now been a total of 34 published preclinical studies assessing stem cell therapy for ED. Of these studies, 19 have focused on cavernous nerve injury (CNI) and 10 focused on diabetes mellitus (DM). The majority of these studies have employed adipose-derived stem cells, and transplantation of the stem cells has mainly been performed via intracavernous injection. Some studies have attempted alternative strategies such as peri-prostatic application (either or not linked to a scaffold) and intravenous injection. 1105

141 Use and Satisfaction in Patients with Peyronies Disease who have Undergone Penile Prosthesis: 1 and 2 Year Followup from the PROPPER Registry

The traditional inflatable penile prosthesis (IPP) reservoir placement is below the transversalis fascia in the space of Retzius. In 2002, Dr. Steve Wilson described ectopic reservoir placement, thereby providing a safe and effective alternative for implant surgeons. This new approach obviated the need for a second incision and decreased operative times during surgery. In the manuscript, he also described the introduction of a reservoir lock-out valve, which prevents autoinflation of the penile implant. The development of lockout valves and flat reservoirs has contributed to the early success and feasibility of submuscular placement techniques. Thirteen years after Dr. Wilsons pivotal study, this technique should be in the armamentarium of all urologic prosthetic surgeons. Accordingly, in certain subsets of patients, ectopic/ submuscular reservoir site placement should be considered a safe, effective alternative to standard reservoir placement in the space of Retzius.