- Email: [email protected]
202 Utilization of Erectile Dysfunction Therapies Following Radical Prostatectomy
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SMSNA Abstracts
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. 200 ASSOCIATION BETWEEN HAND-GRIP STRENGTH AND ERECTILE DYSFUNCTION IN OLDER MEN Park, K.1; Chung, H.S.1; Shin, M.H.2 1 Department of Urology, Chonnam National University Medical School, Gwangju 501-757, Republic of Korea; 2Department of Preventive Medicine, Chonnam National University Medical School, Gwangju 501-746, Republic of Korea Objective: Physical fitness and activity has an important role to prevent chronic disease in the ageing people. However, there are few studies on the association between physical fitness and erectile dysfunction. We aimed to evaluate the association between hand-grip strength and erectile dysfunction in community-dwelling Korean men aged 55 years or older. Methods: This cross-sectional study included 1,771 participants in the Dong-gu Study. Hand grip strength was measured using a handheld dynamometer. Erectile dysfunction was questioned with the Korean version of International Index of Erectile Function questionnaire (IIEF). Erectile dysfunction was categorized as none to mild (13-30) and moderate to severe (0-12) based on IIEF-EF scores. Multivariable logistic regression was conducted adjusting for potential confounders. Results: The proportion of men with moderate to severe erectile dysfunction was 48.8%. The age-adjusted erectile dysfunction score increased with increasing quartile of hand grip strength (11.0, 12.4, 13.4, and 14.0 in the lowest, second, third, highest quartiles, respectively). After adjusting for potential confounders, greater hand grip strength was associated with lower risk of erectile dysfunction (odds ratio [OR], 0.96 per 1 kg; 95% confidence interval [CI], 0.94e0.98). In addition, a high level of moderate to vigorous physical activity was associated with a lower risk of erectile dysfunction (OR, 0.75; 95% CI, 0.61-0.93). Conclusions: In this study, men with low hand grip strength had an increased risk of erectile dysfunction. This result suggests that reduced physical functioning may contribute to erectile dysfunction in aging men. Disclosure: Work supported by industry: no.
Objectives: Plication of tunica albuginea avoids excising the tunica, thus minimizes complications including erectile dysfunction. Although patients usually hesitate to undergo the procedure due to shortening of erectile penile length, it is mostly performed with the safest results. We investigated and compared the long term follow-up results according to the applied plication methods. Material and Methods: A total of 43 men with penile curvature less than 60 underwent corporeal plication since 1996. 37 of them were diagnosed as Peyronie disease, and the remaining 6 were diagnosed as congenital penile curvature. Lue’s technique applied in 30 patients and Essed-Schroeder technique in 13 patiens. All patients were followed-up at least more than 12 months. We investigated the degree of curvature, presence of palpable nodule preoperatively, and penile pain, preservation of sexual function and patient satisfaction postoperatively. Results: Mean patient age was 52.3 years old (17-69) and degree of preoperative curvature was 32.3±21.7 . Mean follow-up period was more than 5 years (63.4±34.7 months). 36 patients (84%) had curvature only and remaining 7 complained concomitant mild erectile dysfunction pre-operatively, however, none of them at baseline was incapable of generating a penetration in erectile rigidity (all grade 3/4 of erection hardness score). And also postoperatively no one complained decreased rigidity. 97.6% of success rate achieved with only one patient failure that recurred curvature 1 month after correction with Lue’s method. Long-term surgical results between two methods did not show the statistical significant difference (p>0.05) in recurrence rate, post-operative pain and patient satisfaction. Conclusion: Plication methods for the treatment of penile curvature achieves good results with minimal recurrence and preserves sexual function very well. We did not find any difference between Lue’s and Essed-Schroeder technique in terms of surgical results. Disclosure: Work supported by industry: no. 202
201
UTILIZATION OF ERECTILE DYSFUNCTION THERAPIES FOLLOWING RADICAL PROSTATECTOMY Kirby, W.1; Chen, M.2; Hockenberry, M.1; Patro, A.1; Farhi, J.3; Pastuszak, A.1; Lipshultz, L.1 1 Baylor College of Medicine, USA; 2SUNY Downstate, USA; 3 University of Virginia School of Medicine, USA
COMPARISON OF PLICATION METHODS FOR THE TREATMENT OF PENILE CURVATURE: LONG TERM SURGICAL RESULTS Yoon, H.S.1; Park, H.Y.2; Chung, W.S.1 1 Department of Urology, Ewha Womans University School of Medicine; 2Hanyang University College of Medicine2, Seoul, Korea
Background: Erectile dysfunction (ED) following radical prostatectomy (RP) has been well described. Treatment traditionally follows a stepwise progression, starting with PDE5 inhibitors (PDE5i) followed by intra-cavernosal injection (ICI) and finally placement of an inflatable penile prosthesis (IPP). Large cohort studies have tried to describe quantitative utilization of these treatments following RP; however, the applicability of these
J Sex Med 2017;14:e1ee104
e86
studies in clinical management is limited due to the use of diagnosis and procedure code data. We sought to better characterize how men specifically seeking care for ED following RP utilized the various available therapies. Methods: Retrospective review of 183 men who had previously undergone radical prostatectomy for prostate cancer between 1993 and 2013, presenting to a single academic urology clinic with a chief complaint of ED. We evaluated the sequential utilization of PDE5i, ICI and IPP in this targeted population. Results: The average age of this cohort at time of RP was 58 years. Every patient was initially managed with PDE5i either individually or in combination. 127 men (69%) progressed to ICI following the initial use of PDE5i. 23 men (12% of the initial study cohort) underwent placement of IPP following ICI. 7 men (4% of the initial study cohort) underwent IPP without first utilizing ICI. Therefore, 30 men (16% of the initial study cohort) underwent placement of IPP for management of ED following RP. Time to progression to IPP was on average 5.8 years following RP. Insurance and Marital status did not differ among the treatment groups. Conclusions: This study showed that nearly 70% of men presenting for management of ED following RP required ICI. This far exceeds the utilization rate of only 2.4% shown in a large cohort study. Further, 16% of this cohort progressed to placement of IPP, which is again greater than the 2.3% utilization rate reported in another large study. Additionally, the average patient in this study did not progress to placement of IPP until nearly 6 years post-operatively e raising the question of whether earlier education and intervention may benefit this population. Disclosure: Work supported by industry: no. 203 MOLECULAR ANALYSIS USING PCR TO AMPLIFY EXTRACTED 16S RIBOSOMAL DNA APPEARS TO IDENTIFY ANTIBIOTIC SENSITIVITIES / RESISTANCE TO BIOFILM FOUND ON PENILE PROSTHESIS IN-VIVO Smith, C.1; Dawn, L.1; Tan, G.1; Henry, G.2 1 LSU, Shreveport, USA; 2Regional Urology, Shreveport, USA Introduction: Previous studies have used traditional culture methods to identify microbial biofilm present at removal and replacement of inflatable penile prostheses. Molecular analysis (PathoGenius Laboratory, Lubbock, Texas) PCR, amplifies extracted 16S ribosomal DNA, which is then sequenced and compared to known bacterial and fungal taxonomies to identify isolates and antibiotic susceptibility. Methods: The purpose of this study is to identify antibiotic sensitivities / resistances to biofilm from penile prostheses at removal / replacement using 16S ribosomal DNA testing. The biofilm pathogen was then evaluated to 34 antibiotics: amikacin, colistimethate (colistin), ceftazidime, ceftibuten, ciprofloxacin (Cipro), meropenem, tmp/smx (Bactrim), trimethoprim, ampicillin, chloramphenicol, erythromycin, gentamicin, neomycin,
SMSNA Abstracts
nitrofurantoin, fosfomycin, levofloxacin, tigecycline, clindamycin (Cleocin), linezolid, vancomycin, metronidazole, ampicillin/sulbactam, azithromycin, doxycycline, imipenem, tetracycline, amoxicillin/clavulanate (Augmentin), piperacillin/tazobactam, cefazolin, cephalexin (Keflex), doripenem, moxifloxacin, Mupirocin (bactroban), and penicillin g. Results: Some of the bacteria identified during 16S ribosomal DNA testing were known prosthetic infectious pathogens. Pathogens found were: Burkholderia cepacia complex, Delftia tsuruhatensis, Campylobacter sp., Serratia marcescens, Propionibacterium acnes, Peptoiphilus sp., Finegoldia magna, Anaerococcus octavius, Staphylococcus epidermidis, Staphylococcus sp., Corynebacterium tuberculostearicum, Propionibacterium (genus), Candida albicans, Alternaria alternate, Corynebacterium bovis, Prevotella ruminicola, Acinetobacter baumannii, Acinetobacter calcoaceticus, Propionibacterium acnes, Actinomyces turicensis, Corynebacterium vitaeruminis, Providencia rettgeri, and Proteiniphilum acetatigenes Conclusions: 16S ribosomal DNA molecular testing has proven to be beneficial in its thorough analysis of antibiotic sensitivities for biofilm found on penile prostheses at the time of surgery. Disclosure: Work supported by industry: yes, by BSCI (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 204 FIBRILLARTM (OXIDIZED REGENERATED CELLULOSE) REDUCES THE RISK OF POSTOPERATIVE HEMATOMA FOLLOWING INFLATABLE PENILE PROSTHESIS Rozanski, A.T.; Liu, A.G.; Shakir, N.A.; Cordon, B.H.; Pagliara, T.J.; Viers, B.R.; Scott, J.M.; Morey, A.F. UTSW, USA Objectives: FibrillarTM, oxidized regenerated cellulose, is a plantbased topical absorbable hemostatic agent that was first introduced in the 1960s and is widely used today in many surgical fields. This study aimed to determine the effect of FibrillarTM on postoperative drain output and subsequent complications following inflatable penile prosthesis (IPP) procedures. Materials and Methods: Starting in March 2016, a practice change occurred at our institution for procedures involving IPPs by a single surgeon. FibrillarTM pledgets began to be included in corporotomy closure. The FibrillarTM group was compared to a control group without FibrillarTM dating back to December 2015. Demographic, intraoperative, and postoperative parameters including cumulative postoperative drain output were evaluated for cases with and without FibrillarTM. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with Fisher’s exact test. Results: A total of 41 men underwent IPP procedures. Median drain output was significantly lower when FibrillarTM was J Sex Med 2017;14:e1ee104
SMSNA Abstracts
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. 200 ASSOCIATION BETWEEN HAND-GRIP STRENGTH AND ERECTILE DYSFUNCTION IN OLDER MEN Park, K.1; Chung, H.S.1; Shin, M.H.2 1 Department of Urology, Chonnam National University Medical School, Gwangju 501-757, Republic of Korea; 2Department of Preventive Medicine, Chonnam National University Medical School, Gwangju 501-746, Republic of Korea Objective: Physical fitness and activity has an important role to prevent chronic disease in the ageing people. However, there are few studies on the association between physical fitness and erectile dysfunction. We aimed to evaluate the association between hand-grip strength and erectile dysfunction in community-dwelling Korean men aged 55 years or older. Methods: This cross-sectional study included 1,771 participants in the Dong-gu Study. Hand grip strength was measured using a handheld dynamometer. Erectile dysfunction was questioned with the Korean version of International Index of Erectile Function questionnaire (IIEF). Erectile dysfunction was categorized as none to mild (13-30) and moderate to severe (0-12) based on IIEF-EF scores. Multivariable logistic regression was conducted adjusting for potential confounders. Results: The proportion of men with moderate to severe erectile dysfunction was 48.8%. The age-adjusted erectile dysfunction score increased with increasing quartile of hand grip strength (11.0, 12.4, 13.4, and 14.0 in the lowest, second, third, highest quartiles, respectively). After adjusting for potential confounders, greater hand grip strength was associated with lower risk of erectile dysfunction (odds ratio [OR], 0.96 per 1 kg; 95% confidence interval [CI], 0.94e0.98). In addition, a high level of moderate to vigorous physical activity was associated with a lower risk of erectile dysfunction (OR, 0.75; 95% CI, 0.61-0.93). Conclusions: In this study, men with low hand grip strength had an increased risk of erectile dysfunction. This result suggests that reduced physical functioning may contribute to erectile dysfunction in aging men. Disclosure: Work supported by industry: no.
Objectives: Plication of tunica albuginea avoids excising the tunica, thus minimizes complications including erectile dysfunction. Although patients usually hesitate to undergo the procedure due to shortening of erectile penile length, it is mostly performed with the safest results. We investigated and compared the long term follow-up results according to the applied plication methods. Material and Methods: A total of 43 men with penile curvature less than 60 underwent corporeal plication since 1996. 37 of them were diagnosed as Peyronie disease, and the remaining 6 were diagnosed as congenital penile curvature. Lue’s technique applied in 30 patients and Essed-Schroeder technique in 13 patiens. All patients were followed-up at least more than 12 months. We investigated the degree of curvature, presence of palpable nodule preoperatively, and penile pain, preservation of sexual function and patient satisfaction postoperatively. Results: Mean patient age was 52.3 years old (17-69) and degree of preoperative curvature was 32.3±21.7 . Mean follow-up period was more than 5 years (63.4±34.7 months). 36 patients (84%) had curvature only and remaining 7 complained concomitant mild erectile dysfunction pre-operatively, however, none of them at baseline was incapable of generating a penetration in erectile rigidity (all grade 3/4 of erection hardness score). And also postoperatively no one complained decreased rigidity. 97.6% of success rate achieved with only one patient failure that recurred curvature 1 month after correction with Lue’s method. Long-term surgical results between two methods did not show the statistical significant difference (p>0.05) in recurrence rate, post-operative pain and patient satisfaction. Conclusion: Plication methods for the treatment of penile curvature achieves good results with minimal recurrence and preserves sexual function very well. We did not find any difference between Lue’s and Essed-Schroeder technique in terms of surgical results. Disclosure: Work supported by industry: no. 202
201
UTILIZATION OF ERECTILE DYSFUNCTION THERAPIES FOLLOWING RADICAL PROSTATECTOMY Kirby, W.1; Chen, M.2; Hockenberry, M.1; Patro, A.1; Farhi, J.3; Pastuszak, A.1; Lipshultz, L.1 1 Baylor College of Medicine, USA; 2SUNY Downstate, USA; 3 University of Virginia School of Medicine, USA
COMPARISON OF PLICATION METHODS FOR THE TREATMENT OF PENILE CURVATURE: LONG TERM SURGICAL RESULTS Yoon, H.S.1; Park, H.Y.2; Chung, W.S.1 1 Department of Urology, Ewha Womans University School of Medicine; 2Hanyang University College of Medicine2, Seoul, Korea
Background: Erectile dysfunction (ED) following radical prostatectomy (RP) has been well described. Treatment traditionally follows a stepwise progression, starting with PDE5 inhibitors (PDE5i) followed by intra-cavernosal injection (ICI) and finally placement of an inflatable penile prosthesis (IPP). Large cohort studies have tried to describe quantitative utilization of these treatments following RP; however, the applicability of these
J Sex Med 2017;14:e1ee104
e86
studies in clinical management is limited due to the use of diagnosis and procedure code data. We sought to better characterize how men specifically seeking care for ED following RP utilized the various available therapies. Methods: Retrospective review of 183 men who had previously undergone radical prostatectomy for prostate cancer between 1993 and 2013, presenting to a single academic urology clinic with a chief complaint of ED. We evaluated the sequential utilization of PDE5i, ICI and IPP in this targeted population. Results: The average age of this cohort at time of RP was 58 years. Every patient was initially managed with PDE5i either individually or in combination. 127 men (69%) progressed to ICI following the initial use of PDE5i. 23 men (12% of the initial study cohort) underwent placement of IPP following ICI. 7 men (4% of the initial study cohort) underwent IPP without first utilizing ICI. Therefore, 30 men (16% of the initial study cohort) underwent placement of IPP for management of ED following RP. Time to progression to IPP was on average 5.8 years following RP. Insurance and Marital status did not differ among the treatment groups. Conclusions: This study showed that nearly 70% of men presenting for management of ED following RP required ICI. This far exceeds the utilization rate of only 2.4% shown in a large cohort study. Further, 16% of this cohort progressed to placement of IPP, which is again greater than the 2.3% utilization rate reported in another large study. Additionally, the average patient in this study did not progress to placement of IPP until nearly 6 years post-operatively e raising the question of whether earlier education and intervention may benefit this population. Disclosure: Work supported by industry: no. 203 MOLECULAR ANALYSIS USING PCR TO AMPLIFY EXTRACTED 16S RIBOSOMAL DNA APPEARS TO IDENTIFY ANTIBIOTIC SENSITIVITIES / RESISTANCE TO BIOFILM FOUND ON PENILE PROSTHESIS IN-VIVO Smith, C.1; Dawn, L.1; Tan, G.1; Henry, G.2 1 LSU, Shreveport, USA; 2Regional Urology, Shreveport, USA Introduction: Previous studies have used traditional culture methods to identify microbial biofilm present at removal and replacement of inflatable penile prostheses. Molecular analysis (PathoGenius Laboratory, Lubbock, Texas) PCR, amplifies extracted 16S ribosomal DNA, which is then sequenced and compared to known bacterial and fungal taxonomies to identify isolates and antibiotic susceptibility. Methods: The purpose of this study is to identify antibiotic sensitivities / resistances to biofilm from penile prostheses at removal / replacement using 16S ribosomal DNA testing. The biofilm pathogen was then evaluated to 34 antibiotics: amikacin, colistimethate (colistin), ceftazidime, ceftibuten, ciprofloxacin (Cipro), meropenem, tmp/smx (Bactrim), trimethoprim, ampicillin, chloramphenicol, erythromycin, gentamicin, neomycin,
SMSNA Abstracts
nitrofurantoin, fosfomycin, levofloxacin, tigecycline, clindamycin (Cleocin), linezolid, vancomycin, metronidazole, ampicillin/sulbactam, azithromycin, doxycycline, imipenem, tetracycline, amoxicillin/clavulanate (Augmentin), piperacillin/tazobactam, cefazolin, cephalexin (Keflex), doripenem, moxifloxacin, Mupirocin (bactroban), and penicillin g. Results: Some of the bacteria identified during 16S ribosomal DNA testing were known prosthetic infectious pathogens. Pathogens found were: Burkholderia cepacia complex, Delftia tsuruhatensis, Campylobacter sp., Serratia marcescens, Propionibacterium acnes, Peptoiphilus sp., Finegoldia magna, Anaerococcus octavius, Staphylococcus epidermidis, Staphylococcus sp., Corynebacterium tuberculostearicum, Propionibacterium (genus), Candida albicans, Alternaria alternate, Corynebacterium bovis, Prevotella ruminicola, Acinetobacter baumannii, Acinetobacter calcoaceticus, Propionibacterium acnes, Actinomyces turicensis, Corynebacterium vitaeruminis, Providencia rettgeri, and Proteiniphilum acetatigenes Conclusions: 16S ribosomal DNA molecular testing has proven to be beneficial in its thorough analysis of antibiotic sensitivities for biofilm found on penile prostheses at the time of surgery. Disclosure: Work supported by industry: yes, by BSCI (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 204 FIBRILLARTM (OXIDIZED REGENERATED CELLULOSE) REDUCES THE RISK OF POSTOPERATIVE HEMATOMA FOLLOWING INFLATABLE PENILE PROSTHESIS Rozanski, A.T.; Liu, A.G.; Shakir, N.A.; Cordon, B.H.; Pagliara, T.J.; Viers, B.R.; Scott, J.M.; Morey, A.F. UTSW, USA Objectives: FibrillarTM, oxidized regenerated cellulose, is a plantbased topical absorbable hemostatic agent that was first introduced in the 1960s and is widely used today in many surgical fields. This study aimed to determine the effect of FibrillarTM on postoperative drain output and subsequent complications following inflatable penile prosthesis (IPP) procedures. Materials and Methods: Starting in March 2016, a practice change occurred at our institution for procedures involving IPPs by a single surgeon. FibrillarTM pledgets began to be included in corporotomy closure. The FibrillarTM group was compared to a control group without FibrillarTM dating back to December 2015. Demographic, intraoperative, and postoperative parameters including cumulative postoperative drain output were evaluated for cases with and without FibrillarTM. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with Fisher’s exact test. Results: A total of 41 men underwent IPP procedures. Median drain output was significantly lower when FibrillarTM was J Sex Med 2017;14:e1ee104