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165 Patient Errors in an Intracavernosal Injection Program
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164 ASSESSING “FAILURE TO CURE” AFTER PENILE PROSTHESIS SURGERY: DO PATIENT PERCEPTIONS COUNT? Pineda, M.A.; Burnett, A.L. Johns Hopkins Medical Institutions, USA Objective(s): A successful penile prosthesis implantation (PPI) surgery may be defined by outcomes beyond the absence of complications. We introduce the concept of Failure To Cure (FTC) in the context of PPI, to determine whether post-surgical outcomes meet all ideal criteria, including ease of use and patient satisfaction. Material and Method(s): Consecutive patients from our sexual function registry who underwent PPI from January 2011 to December 2013 were analyzed. Demographics, previous treatment of erectile dysfunction (ED), comorbidities, post-surgical problems (POP) and social history were tabulated. Patients completed the International Index of Erection Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. We defined a complication, per the Clavien-Dindo classification, as any deviation from the ideal post-operative course that is not inherent in the procedure and does not comprise a FTC. FTC was defined as POP that were not complications. Chi-square tests, t-tests or Wilcoxon rank sum tests were used. Result(s): Our enrollment comprised 185 patients, of which we contacted 124 (67%). Of these, 16 (12.9%) had POP requiring reoperation. Eight patients experienced surgical complications (3 infections, 4 erosions and 1 chronic pain). Eight patients experienced FTC (4 malposition and 4 malfunction). Factors that correlated with POP were previous PPI, body mass index (BMI) > 30kg/m2, and previous treatment with intracorporal injections (ICI) (all p < 0.05). Patients who had POP scored significantly lower on the IIEF erectile function, and intercourse satisfaction domains (both p < 0.05) but not in the orgasmic function, sexual desire and overall satisfaction domains (all p > 0.05). Conclusion(s): Patient-reported outcome assessments can vary greatly from what physicians determine to be successful PPI. An assessment of POP encompasses more than just complication rates, but also reflects FTC. Even when complications occur, patients can still derive satisfaction. Factors that possibly predispose to POP include previous PPI surgery, BMI > 30kg/m2, and history of ICI. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 165 PATIENT ERRORS IN AN INTRACAVERNOSAL INJECTION PROGRAM Teloken, P.; Ortega, Y.; Narus, J.; Garcia, D.; Wochasty, N.; Mulhall, J. Memorial Sloan-Kettering Cancer Centre, USA
SMSNA Abstracts
Table 1. Predictor of Occurrence of Major Error
Odds Ratio
95% CI
P Value
Patient age <40 years
1.4
1.1-2.6
<0.05
Graduate level education (vs other)
4.7
2.1-5.2
<0.01
Duration in ICI program <12 months
1.6
1.4-3.9
<0.01
Objective: To characterise patient errors in an established intracavernosal injection (ICI) program. Methods: Patients enrolled in our ICI program attend clinic for two nurse practitioner (NP) led training visits where the technical aspects are taught and dose titration is begun. Patients are given the following explicit instructions during training, both verbally and in written form (i) to hold pressure on the injection site to limit bruising/hematoma formation (ii) to avoid self titration of medication dose (iii) to avoid injecting a second time (double injecting) if an inadequate response experienced (iv) to change the bottle of medication at least every 6 months. Records were reviewed of men using ICI for 6 months. Errors were listed as minor (zero response injection, penile bruising, expired medication) and major (those potentially leading to priapism - dose self-titration, double injecting). Multivariable analysis was used to define predictors of the major error. Results: ICI patients were included for analysis. Mean patient was 66±22 (29-91) years. 41% were graduate level educated, 48% college, 11% high school. Mean follow-up was 3.2±7.6 (0.5-12) years. The agents used were: trimix (62%), bimix (35%), papaverine (2%), PGE1 (1%). 42% of patient committed at least one error during their time in the program. Errors included: zero response (8% of patients), penile bruising (34%), use of an expired bottle (18%), self-titration (5%) and double injecting (4%). 12% of men committed 1 error during their time in the program. Predictors of the occurrence of a major error included: young age, graduate level education, injection use <12 months (see Table). Conclusions: The majority of patients were error free with the majority of errors being minor. Major errors occurred in less than 10% of patients and were most likely to occur early on in the patients’ experience, in younger men and in men of graduate level education. Disclosure: Work supported by industry: no. 166 REGULAR LOW DOSE SILDENAFIL REDUCES VENOUS LEAK RATES AFTER RADICAL PROSTATECTOMY Tal, R.; Berookhim, B.; Stember, D.S.; Jenkins, L.; Narus, J.; Garcia, D.; Wolchasty, N.; Mulhall, J.P. Memorial Sloan Kettering Cancer Center, USA J Sex Med 2017;14:e1ee104
164 ASSESSING “FAILURE TO CURE” AFTER PENILE PROSTHESIS SURGERY: DO PATIENT PERCEPTIONS COUNT? Pineda, M.A.; Burnett, A.L. Johns Hopkins Medical Institutions, USA Objective(s): A successful penile prosthesis implantation (PPI) surgery may be defined by outcomes beyond the absence of complications. We introduce the concept of Failure To Cure (FTC) in the context of PPI, to determine whether post-surgical outcomes meet all ideal criteria, including ease of use and patient satisfaction. Material and Method(s): Consecutive patients from our sexual function registry who underwent PPI from January 2011 to December 2013 were analyzed. Demographics, previous treatment of erectile dysfunction (ED), comorbidities, post-surgical problems (POP) and social history were tabulated. Patients completed the International Index of Erection Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. We defined a complication, per the Clavien-Dindo classification, as any deviation from the ideal post-operative course that is not inherent in the procedure and does not comprise a FTC. FTC was defined as POP that were not complications. Chi-square tests, t-tests or Wilcoxon rank sum tests were used. Result(s): Our enrollment comprised 185 patients, of which we contacted 124 (67%). Of these, 16 (12.9%) had POP requiring reoperation. Eight patients experienced surgical complications (3 infections, 4 erosions and 1 chronic pain). Eight patients experienced FTC (4 malposition and 4 malfunction). Factors that correlated with POP were previous PPI, body mass index (BMI) > 30kg/m2, and previous treatment with intracorporal injections (ICI) (all p < 0.05). Patients who had POP scored significantly lower on the IIEF erectile function, and intercourse satisfaction domains (both p < 0.05) but not in the orgasmic function, sexual desire and overall satisfaction domains (all p > 0.05). Conclusion(s): Patient-reported outcome assessments can vary greatly from what physicians determine to be successful PPI. An assessment of POP encompasses more than just complication rates, but also reflects FTC. Even when complications occur, patients can still derive satisfaction. Factors that possibly predispose to POP include previous PPI surgery, BMI > 30kg/m2, and history of ICI. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 165 PATIENT ERRORS IN AN INTRACAVERNOSAL INJECTION PROGRAM Teloken, P.; Ortega, Y.; Narus, J.; Garcia, D.; Wochasty, N.; Mulhall, J. Memorial Sloan-Kettering Cancer Centre, USA
SMSNA Abstracts
Table 1. Predictor of Occurrence of Major Error
Odds Ratio
95% CI
P Value
Patient age <40 years
1.4
1.1-2.6
<0.05
Graduate level education (vs other)
4.7
2.1-5.2
<0.01
Duration in ICI program <12 months
1.6
1.4-3.9
<0.01
Objective: To characterise patient errors in an established intracavernosal injection (ICI) program. Methods: Patients enrolled in our ICI program attend clinic for two nurse practitioner (NP) led training visits where the technical aspects are taught and dose titration is begun. Patients are given the following explicit instructions during training, both verbally and in written form (i) to hold pressure on the injection site to limit bruising/hematoma formation (ii) to avoid self titration of medication dose (iii) to avoid injecting a second time (double injecting) if an inadequate response experienced (iv) to change the bottle of medication at least every 6 months. Records were reviewed of men using ICI for 6 months. Errors were listed as minor (zero response injection, penile bruising, expired medication) and major (those potentially leading to priapism - dose self-titration, double injecting). Multivariable analysis was used to define predictors of the major error. Results: ICI patients were included for analysis. Mean patient was 66±22 (29-91) years. 41% were graduate level educated, 48% college, 11% high school. Mean follow-up was 3.2±7.6 (0.5-12) years. The agents used were: trimix (62%), bimix (35%), papaverine (2%), PGE1 (1%). 42% of patient committed at least one error during their time in the program. Errors included: zero response (8% of patients), penile bruising (34%), use of an expired bottle (18%), self-titration (5%) and double injecting (4%). 12% of men committed 1 error during their time in the program. Predictors of the occurrence of a major error included: young age, graduate level education, injection use <12 months (see Table). Conclusions: The majority of patients were error free with the majority of errors being minor. Major errors occurred in less than 10% of patients and were most likely to occur early on in the patients’ experience, in younger men and in men of graduate level education. Disclosure: Work supported by industry: no. 166 REGULAR LOW DOSE SILDENAFIL REDUCES VENOUS LEAK RATES AFTER RADICAL PROSTATECTOMY Tal, R.; Berookhim, B.; Stember, D.S.; Jenkins, L.; Narus, J.; Garcia, D.; Wolchasty, N.; Mulhall, J.P. Memorial Sloan Kettering Cancer Center, USA J Sex Med 2017;14:e1ee104