1804 PENILE REVASCULARIZATION IN VASCULOGENIC ERECTILE DYSFUNCTION: LONG-TERM FOLLOWUP

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secondary infection-related revision events reported after surgery for two groups of patients implanted with 3-piece IPPs: IPPs impregnated with minocycline and rifampin (M/R) versus non-impregnated IPPs. Only men receiving these implants in their first known revision surgeries for replacement or revision of previously implanted penile prostheses were analyzed. The reasons for the revision surgeries during which the IPPs followed in this study were implanted included initial device infections, mechanical malfunctions, and other issues. Life table survival analysis was performed to compare infection-related events resulting in a second surgical revision subsequent to the revision implantation for the two groups. RESULTS: There were 9,300 men in the M/R-impregnated group, and 1,764 men in the non-impregnated group. The total number of implants with revision events due to infection reported at any time during the study interval after the IPP revision implantations was 229 (2.5%) for the M/R-impregnated group, and 66 (3.7%) in the nonimpregnated group. Over the 6.6-year life table analysis, the infectionrelated revision rate after IPP revision implantations was significantly lower for patients receiving M/R-impregnated implants versus those receiving non-impregnated implants (log rank p-value ⫽ 0.0252). CONCLUSIONS: This long-term device survival analysis provides clinical evidence of a significant reduction in infection-related events requiring additional revision subsequent to the use of antibioticimpregnated IPPs compared with non-impregnated IPPs for replacement or revision of previous penile implants. Source of Funding: None

Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011

Table 1. Comparison of the Baseline Characteristics and Changes in IIEF Domains Following Prostate Biopsy Positive Negative All Biopsy Biopsy Patients Mean Age (years) 65.3 62.3 63.4 Mean PSA (ng/ml) Time Post-Biopsy Assessment (days)

4.2

7.0

6.0

83.3

157.2

146.5

⫺15.0

⫹4.4

⫹2.1

Mean Change Erectile Function Subdomain

⫺8.2

⫹2.1

⫹0.1

Mean Change Orgasmic Function Subdomain

⫺2.1

⫹0.5

⫹0.1

Mean Change Sexual Desire Subdomain

⫺0.3

⫹0.1

⫹0.1

Mean Change Intercourse Satisfaction Subdomain

⫺2.7

⫹0.4

⫺0.2

Mean Change Overall Satisfaction Subdomain

⫺1.5

⫹0.6

⫹0.2

Mean Change Total IIEF

Source of Funding: Supported in part by the Urological Research Foundation, Prostate SPORE Grant (P50 CA9038605S2) and the Robert H. Lurie Comprehensive Cancer Center Grant (P30 CA60553)

1804 PENILE REVASCULARIZATION IN VASCULOGENIC ERECTILE DYSFUNCTION: LONG-TERM FOLLOWUP

1803 PROSTATE CANCER DIAGNOSIS IS ASSOCIATED WITH AN INCREASED RISK OF ERECTILE DYSFUNCTION FOLLOWING PROSTATE BIOPSY Brian T. Helfand*, Jason C. Hedges, John Cashy, Barry B. McGuire, William J. Catalona, Kevin T. McVary, Chicago, IL INTRODUCTION AND OBJECTIVES: Prostate biopsy is the preferred diagnostic procedure for prostate cancer (CaP) screening. There is controversy whether men experience transient changes in erectile function (EF) and/or lower urinary tract symptoms (LUTS) after biopsy. However, risk factors for subsequent erectile dysfunction (ED) or increased LUTS have not been reproducibly identified. Therefore, we prospectively evaluated the EF, LUTS and associated characteristics of men undergoing biopsy. METHODS: Between April 2008 and June 2010, 87 men were prospectively administered the 15 item International Index of EF (IIEF) questionnaire and American Urologic Association symptom score (AUA-SS) and quality of life (QoL) questionnaires ⱕ1 month before biopsy and at follow up visit ⱕ12 months. All men included in this study underwent a single 12-core prostate biopsy. Comparison of IIEF and AUA-SS scores based upon baseline characteristics and CaP diagnostic outcome were obtained. RESULTS: There were no significant differences between the total pre-biopsy (47.1⫾20.9 points) and post-biopsy IIEF scores (49.2⫾21.2 points). Similarly, there were no overall differences in preand post-biopsy IIEF subdomain scores. 19% of men had biopsy proven CaP. Interestingly, subgroup analysis of these men with CaP on biopsy showed significantly lower post-biopsy IIEF scores compared to men without CaP (37.3 vs. 52.3 points; p⬍0.001). Specific analyses of the baseline characteristics, changes in total IIEF scores and IIEF subdomain scores in these groups are shown below (Table 1). There were no differences in AUA-SS or QoL scores in the overall population or based upon CaP diagnosis or number of biopsies. CONCLUSIONS: CaP diagnosis appears to have an adverse effect on the EF of men undergoing biopsy, even prior to the initiation of treatment. This study highlights a potential negative psychologic confounder that may influence EF. Additional prospective trials evaluating these relationships are required.

¨ nen, Onder Kayigil*, Emrah Okulu, Mustafa Aldemir, Efe O Ankara, Turkey INTRODUCTION AND OBJECTIVES: Penile revascularization(PR) in vasculogenic erectile dysfunction represents a physiologic attempt to restore erection, and it is the only causal therapy for erectile failure. Patient selection is the most important factor for the best outcome and long-term success of after penile arterial revascularization. This study aim to determine the overall long-term success of PR and to investigate the effect of risk factors on the results of modified Furlow-Fisher technique. METHODS: Between 1997 and 2008, 125 patients with an average age of 43.2 years underwent penile revascularization surgery. A total of 110 patients completed the long-term follow-up with a mean follow-up of 73.2 months. Diagnostic evaluations, penile color Doppler ultrasonography, CC-EMG, and cavernosometry, were performed in all the patients preoperatively. All the patients were asked to answer a 15-item questionnaire IIEF pre and postoperatively. The findings on all five domains of the IIEF were recorded. The efficacy of the operation was assessed as improvement or failure according to the change in the five-item version of the IIEF (IIEF-5). At least five points of increase in the IIEF-5 score during the latest patient visit in the postoperative period compared with the preoperative period was regarded as improvement (surgical success). Other results were regarded as failure. RESULTS: The mean total IIEF score was 30.1⫾7.7 before the operation, and it was 45.3 ⫾ 10.3 at the end of the follow-up (p⬍0.05). The mean IIEF-5 score was 7.3 ⫾ 3.2 before the operation, and it was 16.8 ⫾ 3.1 at the end of the follow-up (p⬍0.05). Preoperatively, the mean erectile function domain score was 10.9 ⫾ 4.4, and it was 18.09 ⫾ 8.1 at the end of the follow-up (p⬍0.05). The success rates were 81.8% in 3-month, 77.2% in 1-year, 70% in 2- year, 66.3% in 3-year and 63.6% in 5-year follow-up in the patients who achieved a no-ED cut off score ⬎26 in IIEF-15. The success rate was the highest in the patients with arteriogenic insufficiency (77.7%). The success rate was the highest in the group of patients with no risk factors (92.8%). Early postoperative thrombosis of anastomosis was determined in 6 patients (5.45%), and incisional hernia was observed in 5 patients (4.54%). Seven patients (6.36%) showed signs of glans hypervascularization as a major complication. CONCLUSIONS: PR operations have not been widely used by urologists due to the technical difficulties and phosphodiesterase inhib-

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itors. However, reported high rates of noncompliance or failure of oral pharmacotheraphy seems likely to increase this operation’s popularity in the near future. Source of Funding: None

1805 SEXUAL FUNCTION BEFORE AND AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA (BPH) Takaharu Ichikawa*, Yasuhiro Nishiyama, Susumu Yamane, Shunji Hayata, Tottori, Japan INTRODUCTION AND OBJECTIVES: We evaluated the impact of holmium laser enucleation of the prostate to the sexual function of patients with symptomatic benign prostatic hyperplasia. METHODS: Between June 2008 and June 2010, 159 patients with a mean age ⫾ SD of 73.3 ⫾ 8.8 years were prospectively recruited in this study. All patients were assessed with the International Prostate Symptom Score (IPSS), 5-item version of the International Index of Erectile Function (IIEF5) before surgery, and at 3, 6, 12 and 24 months. At each visit, peak urinary flow rates (Qmax) and post-void residual urine (PVR) were also evaluated. RESULTS: HoLEP was performed successfully in all patients. There were no major intraoperative or postoperative complications, and no blood transfusions were required. Significant improvements were seen in IPSS, Qmax, and PVR over baseline at each follow-up visit (p⬍0.05). On the contrary, IIEF5 scores at 3 and 6 months after surgery were significantly decreased (p⫽0.0001). At 12 and 24-month followups, IIEF5 scores had recovered to baseline, but no significant erectile function improvement was found after surgery such as IPSS, Qmax and PVR. CONCLUSIONS: There was a temporary decrease of erectile functions after HoLEP, although, after one year it had recovered to baseline. We should give this information to patients along with the expectation of significant improvements of urinary parameters before HoLEP.

IIEF5

Changes in IIEF5 and urinary parameters baseline 3 month 6 month 12 month 6.3 4.9 5.1 5.4

IPSS

19.2

QOL

4.6

2.4

2.0

1.9

1.6

Qmax

9.4

18.4

19.1

20.8

19.2

247.0

23.0

22.2

26.6

10.4

PVR

10.4

8.3

8.3

24 month 7.9 9.4

Source of Funding: None

1806 CORRELATION OF PROXIMAL AND DISTAL CORPUS CAVERNOSUM BIOPSY WITH COLOUR DOPPLER ULTRASONOGRAPHY IN ISCHAEMIC PRIAPISM Evangelos Zacharakis*, Asif Muneer, Maj Shabbir, Alex Freeman, Suks Minhas, Clare Allen, Alex Kirkham, David Ralph, London, United Kingdom INTRODUCTION AND OBJECTIVES: Ischaemic priapism is a urological emergency. Ischaemia within the corpus cavernosum results in the development of smooth muscle dysfunction followed by corporal fibrosis if the priapism persists. Colour doppler ultrasonography of the penis is the imaging test of choice to assess blood flow within the corpora cavernosa. However, the Doppler studies can be difficult to interpret in patients who have either a delayed presentation or who have undergone interventions already. The Doppler studies may report areas of perfusion within the proximal corpora despite the clinical picture being consistent with an ischaemic priapism. The aim of the study was to compare the histological changes in the corpora caver-

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nosa of patients presenting with ischaemic priapism with the results of the Doppler studies in order to evaluate the predictive value of Doppler ultrasound. METHODS: Over a 12 month period 12 patients with priapism were referred to our centre. The mean age was 42 years (range 24 –58 years) and the median time of developing the priapism was 96 hours (range 24 –360 hours). The aetiology was sickle cell disease (5 patients), idiopathic (5 patients) and antipsychotic agents (2 patients) All of the patients underwent a Doppler ultrasound prior to surgical intervention. Biopsies from both distal and proximal ends of both corpora were obtained from all the 12 patients with ischaemic priapism. Biopsies were taken during the ¡T-shunt¢ procedure (n⫽6) and proximal open corporotomy procedure (n⫽6). RESULTS: A total of 11 patients underwent early penile prosthesis implantation, as there was recurrence of priapism after the initial surgical management. Only in one case was the ¡T shunt¢ was successful, however the patient developed delayed erectile dysfunction seconday to extensive corporal fibrosis. Histological analysis in all cases showed extensive or focal necrosis in both the distal and proximal segments of the corpora cavernosa. By contrast, the ultrasonography studies demonstrated a small amount of flow within the corpora in 50% of cases within the proximal corpora with no indication of the degree of fibrosis in the tissue. CONCLUSIONS: In men presenting with ischaemic priapism for more than 24 hours, significant histological changes of the corpus cavernosum due to the development of hypoxia and acidosis. The patients may end up with severe erectile dysfunction due to extensive or focal necrosis of the cavernosal smooth muscle. Although colour Doppler ultrasonography of the penis is a useful imaging test in ischaemic priapism the presence of flow within the proximal corpora does not correlate with smooth muscle viability. Source of Funding: None

1807 REVIEW OF 1103 INFLATABLE PENILE PROSTHETIC SURGERIES PERFORMED IN 2009 DEMONSTRATES ALMOST COMPLETE VARIABILITY FOR IRRIGATION AND ANTIBIOTIC PRACTICE AMONGST ELEVEN HIGH-VOLUME RECONSTRUCTIVE SURGEONS Anthony J Bella*, Ottawa, Canada; Brian S Christine, Birmingham, AL; Gerard Henry, Shreveport, LA; Andrew C Kramer, Baltimore, MD; Eugene Rhee, San Diego, CA; Mohit Khera, Houston, TX; William O Brant, Salt Lake City, UT; Nelson E Bennett, Burlington, MA; Edward Karpman, El Camino, CA; LeRoy A Jones, San Antonio, TX; Rafael Carrion, Tampa Bay, FL INTRODUCTION AND OBJECTIVES: Irrigation during inflatable penile prosthesis (IPP) surgery is considered routine as part of the effort to decrease infection rates. However, little evaluation of this practice has been performed, and there is wide variation between surgeons and sites regarding the type of irrigant utilized (with or without single or combination antimicrobials). There is also a trend toward irrigant type determined by hospital surgical committees. To date, there is little agreement whether to cease irrigation when the IPP is introduced into the penis (this may or may not be a factor for antibiotic impregnated devices) or continue until the end of the procedure. We report a contemporary series focusing on irrigation practices, antiobiotic usage and overall rates of infection in both virgin and revision IPP surgeries. METHODS: 11 high volume penile implant surgeons provided 2009 data for number of cases performed and the primary endpoint of device infection. Type of irrigation fluid utilized, usage of irrigant intraoperatively (cessation at IPP placement versus end of case), and antibiotic regimen (pre-and post- surgery) were determined. RESULTS: A total of 732 virgin prostheses and 371 revision surgeries comprised this cohort. For the first-time implant cohort, 7 infections occurred (1%), whilst 14 (3.8%) were identified in the revision group. Of the 11 surgeons, only two shared a common irrigation