Lybbert, Daniel

Abstract Introduction The Penuma ® implant is a medical-grade silicone implant used in the cosmetic augmentation of the penis. Reportedly 3-11% of devices are being removed over time for reasons such as infection, pain, and dissatisfaction with the device. Objective Despite this, there remains a paucity of information demonstrating safe removal of this device. In this video, we outline intra-operative considerations to promote the safe removal of the Penuma device. Methods Sharp and blunt dissection to the level of the capsule is performed via the original incision line. The proximal end of the device is identified via sharp dissection through the capsule. The penis is then everted to expose the distal attachments of the implant, which are subsequently dissected. Superficial and sharp dissection to remove the mesh is performed. We avoid the use of cautery to prevent damage to the nearby neurovascular bundle. Once the mesh and all permanent material is removed, haemostasias is achieved. A drain may be placed. The incision is irrigated and closed in a multi-layer fashion. Results Here we demonstrate a safe and feasible method to surgically remove the Penuma (Himplant) device. Conclusions In conclusion, the Penuma ® implant is a medical-grade silicone implant used in the cosmetic augmentation of the penis that can be safely removed surgically in the event of infection, pain, or dissatisfaction with the device. Disclosure No

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.