Hashemi, Milad Bonakdar

Abstract Introduction The optimal antimicrobial prophylaxis strategy for inflatable penile prosthesis (IPP) surgery remains a subject of ongoing investigation. Our institution recently discontinued the use of chlorhexidine gluconate (CHG) and returned to traditional antibiotic-based prophylaxis protocols. Objective To evaluate infection rates following the reinstitution of antibiotic-based prophylaxis after discontinuing CHG in IPP surgery. Methods We conducted a retrospective, consecutive cohort study of patients who underwent Coloplast Titan IPP insertion between May 2024 and May 2025. The antibiotic prophylaxis protocol consisted of rifampin/gentamicin device dipping and vancomycin/gentamicin irrigation. Primary and revision cases were analyzed separately. Results A total of 188 patients underwent IPP insertion during the study period, including 119 primary implantations and 69 revision procedures. Mean patient age was 69.6 ± 11.5 years, BMI was 27.6 ± 4.2 kg/m2, and operative time was 67.1 ± 24.1 minutes. No infections occurred in the primary implantation cohort. One infection (1.4%) occurred in the revision group in a diabetic patient with prolonged operative time (176 minutes). Compared to our previously published data using CHG, infection rates decreased significantly in the revision group (1.4% vs. 9.67%, p < 0.001), while the primary group showed a numerical reduction from 2.22% to 0%. Conclusions The reinstitution of antibiotic following discontinuation of CHG resulted in significantly lower infection rates, particularly in revision cases. These findings support the continued use of antibiotic dipping and irrigation protocols for IPP surgery as a safe and effective strategy for infection prevention. Disclosure No

Abstract Introduction Inflatable Penile Prostheses (IPPs) are a surgical implant used to treat erectile dysfunction in patients who do not respond to clinical treatments. IPP cylinder size often changes with cylinder exchange upon revision, but trends in these changes have not been formally assessed in the existing literature. Objective To analyze patient data for changes in implant size upon first revision. Methods Data included patients who underwent IPP surgical revision at Mayo Clinic Rochester between January 2021 and May 2024. Inclusion criteria specified cylinder exchange upon first revision of the IPP. A total of 48 patients were included in the analysis. A Bayesian regression was used to estimate the posterior probability of an increase in cylinder size upon first revision, after adjusting for patient age, revision service provider, and duration between implant and revision as covariates. Linear regression was used to assess the relationship between the extent of cylinder size increase and duration before revision. Results The median increase in cylinder size is 2 cm for the left cylinder and 1.75 cm for the right cylinder. The median increase for each patient’s average cylinder size is 1.625 cm. The median percentage increase in cylinder size is 9.76% for the left cylinder and 8.11% for the right cylinder. The median percentage increase for each patient’s average cylinder size is 8.13%. Posterior probabilities of increase were significant for the left cylinder, right cylinder, and the average cylinder size (Left PP: 97.53%; Right PP: 98.05%; Average PP: 98.05%). The extent of cylinder size increase is not significantly associated with duration before revision (Left p-value = 0.476; Right p-value = 0.500). Conclusions Patients and surgeons can expect about a 10% increase in cylinder size with their first revision. However, the extent of increase is not significantly associated with the duration between implant date and first revision. Future research efforts should focus on identifying where exactly this additional size is generated and what extent of size increase amounts to a noticeable difference for patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Abstract Introduction While Rezum therapy has demonstrated efficacy in treating lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), its outcomes in catheter-dependent patients remain poorly characterized. Objective This study evaluates the efficacy of Rezum therapy in catheter-dependent patients, assesses treatment success rates, and identifies predictors of successful catheter independence. Methods We conducted a retrospective analysis of 597 patients who underwent Rezum therapy for BPH between 2019-2023, identifying 53 catheter-dependent patients (45 with indwelling catheters, 8 requiring clean intermittent catheterization). Voiding trials were attempted at one-month post-procedure, with follow-up stratified into three intervals: 3 months, 6-9 months, and 1-3 years. Univariable and multivariable regression modeling identified predictors of persistent urinary retention. Results Among the 53 patients, 45 had indwelling catheters while 8 required CIC. The majority of patients (90.5%, 48/53) had an American Society of Anesthesiology (ASA) score of 2 or 3, limiting them to procedures under local anesthesia or brief general anesthesia. Sexual function preservation was a priority for all ASA 1 patients (5/5) and approximately half of ASA 2 patients (6/13). Among the 11 sexually active patients, 90.9% (10/11) reported no change in erectile function at three months, with one patient reporting improvement. Regarding ejaculatory function, 81.8% (9/11) reported no changes, one patient reported improvement, and one patient experienced intermittent antegrade ejaculation. At one-month post-surgery, 47% of patients (25/53) achieved spontaneous voiding, including 24 patients with previous indwelling catheters and one patient with prior CIC. By three months, 60.4% of patients (32/53) were voiding spontaneously, comprising 30 patients who previously had indwelling catheters and 2 patients who had performed CIC. Among the 32 patients voiding spontaneously at 3 months, uroflowmetry was available for 18 patients, showing a median maximum flow rate (Qmax) of 12.8 ml/s (IQR: 10.5–16.4) and median post-void residual volume of 59 ml (IQR: 29–167). Quality of life significantly improved, with median IPSS-QoL scores decreasing from 5 (IQR: 4–5) preoperatively to 2 (IQR: 1–3) postoperatively (p<0.001). At 6-9 months follow-up, 62.5% of patients (25/40) with documented visits remained catheter-free, while 8 patients continued CIC and 5 retained indwelling catheters. At the final follow-up period of 1-3 years, 69% of patients (17/25) remained catheter-free, with 6 patients performing CIC and 2 patients maintaining indwelling catheters. Multivariable analysis revealed that patients receiving more Rezum treatments had significantly higher odds of treatment success compared to those receiving fewer treatments (OR = 4.08, 95% CI: 1.12–14.8, p = 0.033). Additionally, larger prostate size was associated with increased odds of treatment response (OR = 1.015, 95% CI: 1.002–1.044, p = 0.042). Conclusions Rezum therapy represents a well-suited treatment option for catheter-dependent BPH patients, particularly those prioritizing sexual function preservation or limited to procedures under local anesthesia. The treatment success positively associated with the number of Rezum treatments administered and larger prostate size. Disclosure No

Abstract Introduction While previous research has explored overall satisfaction following IPP surgery, the specific relationship between final implant length and perceived satisfaction in both patients and their partners remains underexplored. Objective We aim to evaluate the association between IPP cylinder length and postoperative satisfaction in both patients and their sexual partners, and to determine whether perceived adequacy of length restoration correlates with overall sexual and psychosocial outcomes. Methods We initiated a registry of patients undergoing surgery for placement of a PP. After consent, perioperative study assessments and follow-ups were conducted. After surgery, patients were directed to fulfill a survey at 6 months and 12 months. Patients who fulfilled both items were included in the analysis. Results A total of 237 patients had a PP placement and completed the first survey and 158 the 12-month survey. The median IPP length was 22 cm (20-23). At 6 months, .189 patients (79.7%) reported moderate to high satisfaction, and this positive response was sustained at 12-months (n=132; 83.5%). At 6 months, 178 patients (75.1%) reported moderate to high partner’ satisfaction, and this positive response was sustained at 12-months (n=129; 81.6%). A regression analysis at 6 months showed a correlation of r=0.148 (p=0.029) and r=0.027 (p=0.743) at 12 months, implying that while significant statistically, it is not strongly related, and other factors are likely contributing to the response. Partner satisfaction showed a correlation of r=0.184 (p=0.008) at 6 months and r=0.032 (p=0.702) at 12 months, again showing no causal relationship between length of the IPP device with perceived satisfaction. A secondary analysis was performed in patients who had prostatectomy and were using vacuum devices before IPP placement (n=51). Of these, 12 (5.1%) reported decreased penile size during pre-op counseling. The median IPP length was 22 cm (19.5-23) and 21 cm (19.6-22) among patients who reported a decrease in size before IPP placement (p=0.574). There was no correlation between this statement and IPP length (p=0.572), nor satisfaction levels in both patients r=0.180 (p=0.221) and partners r=0.015 (p=0.921) at 6 months or 12 months r=0.060 (p=0.701) & r=0.078 (p=0.636). Conclusions IPP length showed a significant correlation but a weak association with patient and partner satisfaction. Our findings underscore the need for a multimodal approach when looking for patient and partner satisfaction and not only to perceived cosmesis. Comprehensive preoperative counseling should address these multidimensional aspects to better align expectations and outcomes. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Clarification: Industry funding only - investigator initiated and executed study

Abstract Background Chlorhexidine gluconate (CHG) (0.05%) has recently been suggested as a dip and irrigation solution at time of inflatable penile prosthesis (IPP) surgery. Aim This study evaluated infection rates before and after implementing CHG protocol while investigating concurrent risk factors contributing to post operative infections. Methods A retrospective, consecutive cohort study was performed that included patients who underwent insertion of a Coloplast Titan IPP including both virgin and revision cases between 2021 and 2024. Cases performed from January 2021 to August 2022 utilized rifampin/gentamicin for dip and vancomycin/gentamicin for irrigation (ABX), whereas those from October 2022 to May 2024 utilized CHG for both dip and irrigation. Perioperative risk factors including dip and irrigation solution used at time of surgery were compared between groups. Outcomes We defined the incidence of postoperative infection and risk factors associated with infection in each group. Results The incidence of infection was significantly higher in the 0.05% CHG group (13/377) compared to the ABX group (0/320) (P < .001). When analyzed separately by subgroup, virgin cases treated with CHG for dip and irrigation demonstrated a significantly higher infection rate (7/315) compared to those in the ABX group (0/280) (P = .012). Similarly, in revision cases, the CHG group also exhibited a significantly higher infection rate (0/40) than the ABX group (6/62) (P = .043). Univariable analysis of the CHG cohort identified three significant risk factors for infection: diabetes mellitus (DM), extended operative time (OP), and revision surgery (P = .003, .001, and < .001, respectively). Multivariable regression analysis revealed that patients with DM had a 5.7-fold increased risk of infection (OR: 5.70, P = .004), while those undergoing revision surgery faced a 5.3-fold higher risk (OR: 5.26, P = .004). Additionally, each minute increase in OP was associated with a 1% higher infection risk (OR: 1.01 per minute, P = .007). These associations remained significant after adjusting for all variables in the model. Clinical Implications Prosthetic surgeons should be cautious about adopting 0.05% CHG for both dip and irrigation in the absence of strong clinical evidence demonstrating its non-inferiority to antibiotic solutions. Strengths and Limitations This is the first clinical study reporting infection rates after IPP surgery using 0.05% CHG for both dip and irrigation. While retrospective and non-randomized, we present a relatively large sample size of patients. Conclusions Our findings identify four risk factors for penile prosthesis infection: usage of the 0.05% CHG solution for dip and irrigation solution of Coloplast hydrophilic-coated devices, DM, revision surgery, and extended OP.

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 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.