Lozoya, A Guillen

Abstract Introduction Device malfunction remains a serious concern for patients with inflatable penile prosthesis (IPP), with pump failure being one of leading causes of revision surgery. Complete device replacement has been the traditional approach, but partial device replacement for the pump may offer a less invasive and cost-effective alternative, with potentially lower complication risk. Objective To evaluate the safety, efficacy, and clinical outcomes of pump replacement (with or without obvious tubing leak/fracture), manipulation or fluid addition in patients undergoing IPP revision surgery. Methods A retrospective review was conducted on patients who underwent IPP pump replacement with or without additional component exchange by a single surgeon, between January 2018 and April 2025. Thirty patients met the inclusion criteria. Clinical, intraoperative and postoperative data were collected and descriptively analyzed. Outcomes included postoperative infectious and non-infectious complication rates. Results The median age at revision was 77 years, with a median time to revision of 76 months post-implantation. Most common indications were frozen or pump difficulties (67%), pump + tubing damage (30%) and fluid addition requirement (10%). No intraoperative complications occurred. Postoperative complications were reported in 3 patients (10.0%), all due to mechanical malfunction, with no infections observed. Median time to complication was 24 months (IQR 7–72). One patient progressed to IPP explanation after successive revisions for impending erosion not thought related to pump manipulation. Another underwent complete replacement at 7 months for fluid leak from reservoir. A third required non-exchange revision at 24 months. The majority (91%) received Coloplast pumps. The median operative time was 53 minutes (IQR 43–70). Conclusions Pump replacement appears to be a safe and effective option for select patients, potentially reducing surgical morbidity and preserving viable components. The absence of infection in this series is reassuring, particularly in a revision setting where infection risk is amplified. Consideration of device age and patient specific factors is important in guiding the choice between partial and complete component exchange. Disclosure No

Abstract Introduction Convective water vapor thermal therapy (Rezum) can have varied outcomes based on prostate architecture. Objective We sought to compare the efficacy of traditional Rezum therapy with steam treatment of the median lobe to transurethral resection for the median lobe, and Rezum treatment for the lateral lobes of the prostate (Rezurp). Methods A single-surgeon series between 2019 and 2024 analyzed standard BPH outcomes. The rate of retreatment, complications, and a global assessment: “Knowing what you know now, would you like to repeat the procedure?” were utilized. Significant median lobe was defined as ≥1 cm of intravesical protrusion for Rezurp patients and ≥ 2 median lobe treatments required for standard Rezum. Results Follow-up assessments were performed for 89/105 patients in the Rezurp group and 107/138 patients in the Rezum group. There was no significant difference in baseline characteristics between the two groups, as shown in Table 1. In the Rezum group, the median IPSS before surgery was 25 (20–28), while the median score after surgery was 9 (5–15), and in the Rezurp group, the median IPSS before surgery was 22.5 (19–28), and the median score after surgery was 5 (3–9.7). The changes were statistically significant for both groups (P < 0.001). For the IPSS quality-of-life (QoL) scores, the median in both groups was 4 (mostly not satisfied) before surgery and 2 (mostly satisfied) after surgery. The changes in QoL scores were significant in both (P < 0.001). In the Rezum group, the median Q-max was 7.9 and 13.1 before and after surgery, while in the Rezurp group, it was 8.0 and 17.1, respectively, and the changes were significant for both (P = 0.001). In addition, changes in post-voiding residue were significant in both groups (P = 0.001) (Table 2). In the Rezum group, 62% (67 patients) were on alpha-blockers before surgery, whereas only 15.8% (17 patients) continued after surgery. For the Rezurp group, 71.9% (64 patients) were on alpha-blockers before surgery, compared to 10.1% (9 patients) afterward. The discontinuation of alpha-blockers was significant for both groups (P = 0.001). Furthermore, changes in stopping the use of 5-alpha reductase inhibitors were significant for both groups (P = 0.001). The changes in stopping PDI-5 were not significant in both groups (P = 0.38). Regarding retreatment, 5.6% (5 out of 89) of patients in the Rezurp group required a retreatment procedure, compared to 14.9% (16 out of 107) in the Rezum group. The retreatment rate was significantly higher in the Rezum group (P = 0.03). When asked if they would repeat the procedure, 91% (81 out of 89) in the Rezurp group expressed interest, compared to 72% (77 out of 107) in the Rezum group. The interest in repeating the procedure was significantly higher in the Rezurp group (P = 0.001). Conclusions Although both Rezum therapy and Rezurp resulted in significant improvements in Q-max, PVR, IPSS, and QoL, the Rezurp group had a significantly lower rate of retreatment. Disclosure No.

Abstract Introduction Surgical treatment options for Peyronie’s disease (PD) include penile plication, plaque excision with grafting, and penile prosthesis placement with straightening maneuvers. Choice of surgical incision depends on location and severity of curve, concomitant procedures, and surgeon preference. Objective To assess risk of wound complications after PD surgery stratified by ventral versus subcoronal incision type. Methods A single surgeon retrospective chart review was conducted for all patients undergoing PD tunica albuginea plication (TA) or plaque excision with grafting (PEG) from Aug 2019 to June 2023. Wound complication was classified as any dehiscence or physical examination finding suspicious for infection within 30d of surgery. A Mann–Whitney U Test was used to compare demographic variables and wound complication rate based on ventral and subcoronal approaches. Results Of the 161 patients included, 105 underwent TAP and 56 underwent PEG. All patients who underwent PEG had at least one plication suture performed to correct mild residual curvature after grafting. A ventral midline penile incision was used in 81 patients (50%) and subcoronal in 80 patients (50%). Wound complications within 30d of surgery were found in 10 patients (6%), including 8 (10%) with ventral incisions versus only 2 (3%) subcoronal (OR 4.27; 95% CI 0.87-20.79; p = 0.09). There was no significant difference in wound complications between TAP and PEG cohorts. Wound complications included dehiscence requiring repeat closure (n = 1) and superficial wound infection necessitating antibiotic therapy (n = 9). In a subgroup analysis of patients who underwent TAP only, 8 patients (7.6%) with a ventral approach experienced a 30d wound complication compared with 1 patient (3.4%) with a subcoronal approach. Conclusions Penile straightening surgeries are associated with a low rate of significant wound infections. While not statistically significant, a ventral incision may have a slightly higher risk than subcoronal for wound complications within the first 30d of surgery. Both ventral and subcoronal incisions can offer excellent exposure and may be considered for patients requiring plication and/or grafting approaches. Disclosure No.

Abstract Introduction The optimal irrigation solution with inflatable penile prosthesis (IPP) remains controversial. Objective We sought to determine the impact of the type of fluid used for dipping and irrigation (D&I) on the risk of IPP infections. Methods This is a retrospective, consecutive cohort study that includes individuals who underwent initial Coloplast IPP insertion or revision between January 2021 and May 2024. Cases done from January 2021 to August 2022 (20 months) underwent Rifampin/Gentamycin for dipping and Vancomycin/Gentamycin for irrigation (Group 1), whereas those from October 2022 to May 2024 (20 months) utilized 0.05% chlorhexidine gluconate for both D & I (Group 2). Surgeon, operative time, age, diabetes mellitus (DM), perioperative level of HbA1C, history of acute urinary retention (AUR), positive urine culture, and oral antibiotic (AB) regimen at discharge were obtained. The rate of infection between the two study groups and the association of risk factors with developing infection were explored by t-test and chi-square analysis for continuous and discrete variables, respectively. P-value less than 0.05 was considered statistically significant. Results In comparison of two study groups, infection rate was significantly higher in group 2 at 2.5% (8/314) than group 1 which did not have any infection (0/280) (P = 0.008). There was no significant association between the study group and operative time (P = 0.45), DM (P = 0.29), HbA1C level (P = 0.20) and AUR (P = 0.87) or surgeon (Table 1). Notably, two clinical infections were from non-virulent organisms (Streptococcus Constellatus & Staphylococcus Lugdunensis). Two of three patients undergoing malleable salvage failed. Since no infection was observed in group1, infection risk predictors were only analyzed in group 2. The patients in group 2 were stratified based on their diabetes mellitus (DM) status, and analyses were conducted to investigate the effect of a positive DM history on the risk of infection. The results indicated that having DM significantly increased the risk of infection, with 75% (6/8) of patients with DM developing an infection compared to 26% (78/306) of those without DM (P = 0.006) (Table 2). Notably, three of eight infections occurred in patients discharged on Augmentin or cefdinir secondary to drug interaction warning (our typical post op prophylaxis is Bactrim or ciprofloxacin). Conclusions Type of antiseptic fluid for D&I and DM were associated with IPP infection following surgery in our patient cohort. Disclosure No.

Abstract Introduction Treatment of patients with obstructive lower urinary tract symptoms has various side effects on their quality of sexual life. Objective This study aimed to compare the effects of Rezum and Rezurp (a combination of Rezum for lateral lobes and TURP for the median lobe) on erections, retrograde ejaculation, and subjective orgasm experience in patients with a significant median lobe. Methods This is a retrospective cohort study that includes patients who underwent Rezum and Rezurp between January 2021 and January 2024. Sexual outcomes were assessed at 3 months and a median follow up phone call was 33 months. Patients were queried: Any changes in erections (yes/no) and changes in ejaculation (yes/no). If yes to changes, patients were asked to further define and characterize their responses including specific effect on orgasm. The effect of surgery on sexual outcomes was explored by chi-square analysis with P ≤ 0.05 considered statistically significant. Results Sexual outcomes were obtained for 78/89 patients in the Rezurp and 97/107 patients in the Rezum group. There was no significant difference in baseline characteristics, including age, prostate volume, and medication regimens, between the two groups, as shown in Table 1. The results indicated that 78% (61/78) and 83% (86/97) of Rezurp and Rezum patients experienced no change in ejaculation. Total ejaculation loss was seen only in two Rezurp patients. Ejaculatory changes between the two groups were not significantly different, with 13.8% and 4.23% worsening for Rezurp and Rezum, respectively (P = 0.08). Changes in erections and orgasm satisfaction were not statistically significant between the two groups (P = 0.76 and 0.54, respectively). Subjective worsening in orgasm quality for Rezurp and Rezum was not different between groups (P = 0.54), with 6.4% and 4.1% worsening, respectively (Table 2). Conclusions Rezurp and Rezum have similar sexual function outcomes. Disclosure No.

Abstract Introduction Semen parameters are a reflection of overall patient health and may fluctuate during times of physiologic stress. Autoimmune disease affects a number of aspects of health and may be exacerbated by disease flare-ups and/or medical therapy. Nearly 5 million men are living with an autoimmune disease, yet its effect on male fertility is not well defined. Objective The object of this study is to evaluate the effect of autoimmune disease and other health factors, such as smoking status, BMI, and age on semen parameters using a large institutional database. Methods We reviewed an institutional database of all patients who underwent as semen analysis for any reason between 2013 and 2019. In addition to autoimmune disease status, patient age, smoking status, and body mass index were noted. Chi-Squared analysis was performed to evaluate the effects of autoimmune disease and smoking status on semen analysis. Univariate analysis was performed to evaluate the effect of age and body mass index on semen analysis. Results Of the 1127 patients in the cohort, 44 patients had a diagnosis of autoimmune disease at the time of semen analysis. Mean age of patients with and without autoimmune disease was noted to be the same at 34 years. No significant difference was noted in semen parameters (motility, pH, concentration, volume, morphology) when comparing patients with autoimmune disease to those without. When looking at factors aside from having an autoimmune disease, smoking status had a significant difference on sperm morphology (p = 0.043) but did not have any significant effect on other semen parameters. Sperm motility (p = <0.01) and volume (p = 0.03) declined with increasing age. Increasing body mass index was associated with increased semen pH (p = 0.03), but otherwise did not impact semen parameters. Conclusions This single center, large retrospective analysis shows no significant impact of autoimmune disease on semen parameters. Smoking and patient age were the only significant factors that influenced semen parameters, while patient age only caused a slight increase in semen pH. Disclosure No.