Guillén-Lozoya, A.H.

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 Many couples who do not achieve pregnancy with intrauterine insemination (IUI) subsequently pursue in vitro fertilization (IVF). While the impact of semen parameters on IUI outcomes is well established, it remains unclear whether characteristics of sperm following IUI preparation predict future IVF success. Many couples who do not achieve pregnancy with intrauterine insemination (IUI) subsequently pursue in vitro fertilization (IVF). While the impact of semen parameters on IUI outcomes is well established, it remains unclear whether sperm characteristics following IUI preparation predict future IVF success. Here we study a novel, clinically accessible marker of sperm quality – percent change in total motile sperm (TMS) after IUI sperm wash-that may predict fertilization and blastulation outcomes in subsequent IVF cycles. Objective This aims to evaluate the association between changes in total motile sperm (TMS) after IUI sperm wash and fertilization rates in subsequent IVF cycles.This study aims to evaluate the association between changes in TMS after IUI sperm wash and fertilization and blastulation rates in subsequent IVF cycles. Methods In this retrospective study, we identified couples at a single academic center who failed to achieve a live birth following IUI and subsequently underwent IVF with the same partner. To minimize confounding, only couples with a diagnosis of unexplained infertility or male factor infertility were included. In patients who underwent multiple IUIs (median of 2), the cycle with the greatest percent decrease in TMS was selected for analysis. Additional predictive variables of female partner age, male partner age, pre-wash TMS, and insemination method were assessed. A stepwise variable selection method was utilized to identify predictors of fertilization rate and complete blastulation failure, with linear and logistic regression models of selected variables developed, respectively. Results From the cohort of 388 couples, the median fertilization rate during IVF was 56% (IQR 43%–70%). Thirteen percent of couples experienced complete blastulation failure. Change in TMS was selected as a predictor of both fertilization rate and blastulation failure. A 10% greater decline in TMS after IUI sperm wash was associated with a 1.02% lower fertilization rate (p=0.052), after adjustment for insemination method. A 10% greater decrease in TMS was associated with a 1.22-times (95% CI 1.04, 1.48) increased odds of blastulation failure (p=0.023) after adjusting for female partner age. Conclusions A greater percent decrease in TMS following IUI sperm wash is associated with lower fertilization rates and a higher odds of blastulation failure in subsequent IVF cycles. These findings support the hypothesis that significant declines in TMS after sperm preparation may reflect underlying sperm quality defects not detected by routine semen analysis, yet still relevant to fertility outcomes. By identifying sperm quality issues not apparent on standard semen analysis, these findings offer a new tool for risk stratification and counseling of couples transitioning from IUI to IVF. Disclosure No

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 Background Erectile dysfunction (ED) is a known precursor and sequela of cardiovascular disease (CVD), with ED severity predicting CVD severity. Aim This study aimed to evaluate the utility of ceramide levels in patients with ED. Methods We initiated ceramide testing in all patients with ED. We retrospectively analyzed ceramide levels from electronic records and stratified by severity of symptoms using the erectile function domain of the International Index of Erectile Function (IIEF). Outcomes The study aimed to determine whether abnormal ceramide levels were associated with ED severity and increased cardiovascular risk. Results Three hundred and fifty-four patients were reviewed, of whom 253 (71.5%) had moderate or higher ED. A statistically significant difference in abnormal ceramide values was found in patients with moderate to severe symptoms, and the odds of getting an abnormal ceramide test were increased based on the IIEF scoring alone (odds ratio [OR] 2.3 [1.04-5.12]; P-value = .034). Clinical Implications Serum ceramide testing could be beneficial in identifying cardiovascular risk in men with ED, potentially prompting cardiac referrals and lifestyle modifications. Strengths and Limitations The strengths of this study include a large sample size and the use of a well-established scale, while the limitations include the retrospective nature of the study and the need for further research to validate the findings. Conclusion Patients undergoing management for ED may benefit from serum ceramide testing and subsequent cardiac referral.

Abstract Background Multiple guideline-based surgical treatment options for Peyronie’s disease (PD) exist, including penile plication and plaque incision or excision and grafting. Surgical incision type may differ depending upon location and severity of curve, planned concomitant procedures, and surgeon preference. Aim To evaluate postoperative wound complications comparing outcomes between ventral and subcoronal incisions in patients undergoing tunica albuginea plication (TAP) and plaque incision or partial excision and grafting (PG) for PD. Methods A single-surgeon, single-center retrospective chart review was conducted on all patients undergoing TAP or PG from 2019 to 2023. Patient demographics, including previous PD treatments, were recorded. A Mann–Whitney U test was utilized to determine differences in wound complication rate, median curvature improvement, and remaining postoperative curvature between ventral and subcoronal approaches. Outcomes Wound complication was classified as any dehiscence and/or wound exudate suspicious for infection within the first 3 months postoperatively. A secondary analysis was performed comparing these outcomes between TAP and PG. Results In the analysis, 189 patients were included, including PD straightening surgery, including 125 patients who underwent TAP (66%) and 64 patients (34%) who underwent PG. Among all cases, 49.7% underwent ventral incision (N = 94) and 50.3% (N = 95) underwent subcoronal incision. A total of 12 patients (6.3%) experienced a wound-related complication postoperatively (range 3-23 days), including 9/94 (9.6%) in the ventral incision cohort and 3/95 (3.2%) in the subcoronal cohort (P = 0.081). All the patients were treated with oral antibiotics and two patients required closure under local anesthesia (both in the ventral incision cohort). Secondary analysis did not reveal any significant difference in outcomes between TAP and PG cohorts with respect to wound complications. Clinical Implications While we did not identify a statistically significant difference, most of our wound complications, including infection and/or dehiscence, were seen in those undergoing a ventral penile raphe incision. Despite this, the rate of wound complications with either incisional approach as low. Strengths and Limitations Our report represents a large cohort of patients treated with surgical straightening for PD, and to our knowledge is one of the first to compare wound complications between ventral and subcoronal incisions. Limitations include the retrospective single-surgeon series without randomization, lack of power analysis, and heterogenous classification of wound complications. Conclusion Both ventral penile raphe and subcoronal (degloving) incisions can be considered for penile straightening procedures to correct PD curvature deformity with a low risk for serious wound-related complications.