Vasdev, Ranveer

Abstract Introduction Clostridium Collagenase Histolyticum (CCH) is the only-FDA approved non-surgical, intralesional option for men with Peyronie’s disease. However, little is known regarding practice patterns of CCH providers due to lack of standardized protocols. Objective To evaluate practice patterns for providers approved to administer CCH to treat Peyronie’s disease (PD), this study was conducted. Methods The “Find a Xiaflex-Trained Urologist” search tool on the Endo International patient-facing website was utilized to identify clinicians offering CCH injections in the United States. A 24-question survey was mailed to these providers with topics including provider type, years in practice, therapies offered, and patient evaluation was distributed to providers on patient-facing Endo International Xiaflex Find a Provider web-based tool. Results 63 responses were obtained, including 41% fellowship-trained urologists (FTU), 40% non-fellowship-trained urologists (NFTU), 14% advanced practice providers, and 5% un-specified. Prior to therapy, over 63% of providers performed in-office assessment of an erect penis while only 35% obtained ultrasound. 32% always and 36% never performed an artificial erection prior to administering CCH. Plaques were most identified by palpation or patient-provided direction with penile modeling and traction the most common adjuncts. When comparing NFTU to FTU, there was no difference in volume of PD patients with 60% examining fewer than 10 per month. FTU were more likely to offer traction (p = 0.002), plaque incision/excision and grafting (p = 0.005), increase time between injections (p = 0.012), and less likely to encourage penetrative intercourse between cycles (p = 0.016). The incidence of post-operative hematomas or suspected corporal rupture was not significantly different, although FTUs were more likely to conservatively manage rupture. Conclusions Variability exists in provider practice patterns surrounding CCH injections with most evaluating less than 10 patients with PD per month. This calls to attention the need for evaluation of techniques, patient outcomes, and standardization of care. Disclosure Yes, this is sponsored by industry/sponsor: Endo Pharmaceuticals. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals.

Abstract Introduction Transurethral bipolar enucleation of the prostate (TUBE) is an enucleation procedure with similar functional urinary outcomes to holmium laser enucleation of the prostate (HoLEP). In comparison to the steep learning curve associated with HoLEP, TUBE appears to be more easily reproductible likely due to pre-existing familiarity with instrumentation. Despite the significant benefits associated with TUBE, retrograde ejaculation has been shown to occur in approximately 44.3% of patients. Objective Patient perspectives have previously emphasized the importance of preserving erectile and ejaculatory function, however the lack of subjective and objective data after TUBE makes it difficult to determine the overall impact on sexual function. We therefore sought to assess the objective and subjective sexual outcomes in men undergoing TUBE. Methods After IRB approval, a retrospective review of 112 patients undergoing transurethral bipolar enucleation procedures with a single surgeon at a tertiary care center was analyzed. The database included patient demographics, prostate information, preoperative uroflow medication, preoperative bladder management, intraoperative characteristics, and pre- and post-operative IIEF scores. To evaluate subjective patient responses, a 21-question survey incorporating the IIEF score and subjective questions to determine ejaculatory, orgasmic, and erectile function was disseminated. Results On objective analysis, smaller prostate size was significantly associated with a lower post-operative sexual satisfaction (p < 0.023). Larger prostates (>125 g & 75-125 g) and the absence of a median lobe were significantly and independently associated with larger changes in post-operative intercourse satisfaction scores (p < 0.05). Intraoperative morcellation, medication usage, preoperative bladder management, and demographic characteristics were not associated with sexual satisfaction scores. On subjective analysis, twenty-seven percent of patients were not engaging in sexual activity post-procedurally. Of the patients that were sexually active, 24% were able to achieve an erection, 36% were almost always or always able to ejaculate, 57% continued to orgasm or climax, and 50% experienced sexual desire more than half of the time. However, 18% of men noted ejaculatory dysfunction contributed to diminished orgasmic function and sensation issues and 37% noted dissatisfaction with orgasms. Conclusions To our knowledge, this is the first study to analyze objective and subjective patient responses to sexual function post-TUBE surgery. On objective analysis, improvements in intercourse satisfaction following TUBE surgery were more common in patients with larger prostate sizes and presence of a median lobe. On subjective analysis, erectile satisfaction rates remained high, however patients endorsed issues with orgasm and ejaculatory function, often associated with retrograde ejaculation. This data will allow us to improve patient counseling preoperatively and potentially offer less aggressive operations in patients who prioritize sexual function. Disclosure No.

Motor units are normally recruited in an orderly manner in order to accomplish ventilatory behaviors. The duration of non‐stationarity in electromyographic (EMG) bursts provides an estimate of the period of motor unit recruitment. Motor unit recruitment also reflects central drive, which can be estimated by the root‐mean‐squared (RMS) EMG value 75 ms after the EMG burst onset (RMS 75 ). Following unilateral diaphragm muscle (DIAm) paralysis induced by upper cervical spinal cord hemisection at C 2 (SH), there is gradual spontaneous recovery of ipsilateral EMG activity. Increased activity of the contralateral (uninjured) DIAm is sufficient to maintain ventilation following SH. We hypothesized that changes in central drive can be estimated by the period of non‐stationarity and RMS 75 from the contralateral DIAm EMG following ipsilateral paralysis and spontaneous recovery of DIAm EMG activity. We found that the duration of non‐stationarity increased to a greater extent in rats that did not recover ipsilateral EMG activity by 14 days post‐SH (D14) compared to those that did. In addition, we found that RMS 75 values following SH were reduced in rats displaying recovery of ipsilateral DIAm EMG activity compared to rats that did not. Collectively, these results suggest that the duration of non‐stationarity and RMS 75 can be used to evaluate recovery of ipsilateral DIAm function following spinal cord injury.